高功率射频消融对心房颤动患者左心房功能的影响

Effect of High Power Radiofrequency Ablation on Left Atrial Function in Patients with Atrial Fibrillation

目的探究高功率射频消融对心房颤动患者左心房功能的影响。方法选取2018年5月至2019年5月河北北方学院附属第一医院收治的心房颤动患者129例,按照治疗方法不同分为A组、B组、C组,各43例。A组患者行临床药物常规治疗,B组患者行低功率射频消融治疗,C组患者行高功率射频消融治疗。计算左心房功能指数(LAFI),使用Philips iE33超声仪测量左心房容积指标[左心房最小容积(LAV min)、左心房最大容积(LAV max)、左心房收缩期前容积(LAV p)]和左心房血流动力学指标[左心房排空分数(LAEF)、左心房主动排空分数(LAAEF)、左心房被动排空分数(LAPEF)]。使用常规二维超声和脉冲多普勒检查测量左心房前后径(LAD)、二尖瓣舒张晚期峰值流速(A峰)、舒张早期峰值流速(E峰)、肺静脉收缩期峰值流速(S峰)、舒张早中期峰值流速(D峰),计算E/A、S/D比值,测量舒张晚期逆向波峰值流速。行组织多普勒成像检查测量舒张晚期运动速度(Aa)、舒张早期运动速度(Ea)及两者比值。统计两组的临床疗效及预后情况。结果LAFI、左心房容积指标、左心房血流动力学指标、右心房超声指标(E/A、S/D值、LAD)、组织多普勒成像指标的组间、时点间、组间和时点间差异有统计学意义(P<0.01),与A组相比,B组、C组LAV min、LAV max、LAV p、LAD、E/A、Ea/Aa显著降低,LAFI、LAEF、LAAEF、LAPEF、S/D值、Ea、Aa显著升高(P<0.05);与B组相比,C组LAV min、LAV max、LAV p、LAD、E/A、Ea/Aa显著降低,LAFI、LAEF、LAAEF、LAPEF、S/D值、Ea、Aa显著升高(P<0.05)。A、B、C组的总有效率分别为55.81%(24/43)、79.07%(34/43)、95.35%(41/43),B、C组总有效率高于A组(P<0.05),C组高于B组(P<0.05)。B组和C组总不良事件发生率低于A组[18.60%(8/43),2.33%(1/43)比51.16%(22/43)](P<0.05),C组低于B组(P<0.05)。结论高功率射频消融可显著改善心房颤动患者左心房功能,降低不良事件发生率,效果显著。

Objective To explore the effect of high power radiofrequency ablation on left atrial function in patients with atrial fibrillation.Methods A total of 129 patients with paroxysmal atrial fibrillation admitted to the First Affiliated Hospital of Hebei North University from May 2018 to May 2019 were included.According to different treatment methods,they were divided into a group A,a group B and a group C,with 43 cases each.The group A was treated with conventional clinical drugs,group B was treated with low power radiofrequency ablation,and group C was treated with high power radiofrequency ablation.The Left atrial function index(LAFI)was calculated,and the left atrial volume index[minimum left atrial volume(LAV min),maximum left atrial volume(LAV max),left atrial pre systolic volume(LAV p)]and left atrial hemodynamic index[left atrial emptying fraction(LAEF),left atrial active emptying fraction(LAAEF),left atrial passive emptying fraction(LAPEF)]were measured by Philips iE33 ultrasonography.The left atrial diameter(LAD),peak A,E,S and D were measured,and E/A,S/D ratio were calculated,and Ar wave was measured by ultrasound two-dimensional echocardiography and pulsed Doppler.The late diastolic velocity(Aa),early diastolic velocity(Ea)and their ratio were measured by tissue Doppler imaging.The clinical efficacy and prognosis of the two groups were statistically recorded.Results There were statistically significant differences in LAFI,left atrial volume index,left atrial hemodynamics index,right atrial ultrasound index(E/A,S/D,LAD),and tissue Doppler imaging index between groups,time points,and interactions of groups and time points(P<0.01).Compared with group A,the LAV min,LAV max,LAV p,LAD,E/A,Ea/Aa in group B and group C were significantly decreased,while the LAAFI,LAEF,LAAEF,LAPEF,S/D value,Ea and Aa were significantly increased(P<0.05).Compared with group B,the LAV min,LAV max,LAV p,LAD,E/A,Ea/Aa in group C were significantly decreased,while the LAAFI,LAEF,LAAEF,LAPEF,S/D,Ea and Aa were significantly increased(P<0.05).The total effective rate of group A,B and C were 55.81%(24/43),79.07%(34/43)and 95.35%(41/43),the total effective rate of group B and C was higher than that of group A(P<0.05),and that of group C was higher than that of group B(P<0.05).The incidence of total adverse events in group B and group C were lower than that in group A[18.60%(8/43),2.33%(1/43)vs 51.16%(22/43)](P<0.05),and that in group C was lower than that in group B(P<0.05).Conclusion High power radiofrequency ablation can significantly improve left atrial function in patients with atrial fibrillation and reduce the incidence of adverse events,showing remarkable effect.