导管消融术对不同起源特发性频发室性期前收缩患者心房功能及BNP的影响

Impact of radiofrequency catether ablation on atrial function and BNP in patients with idiopathic and frequent ventricular premature contractions of different origins

目的通过对比不同起源部位特发性频发室性期前收缩患者行导管射频消融术(radio-frequeney catheter ablation,RFCA)术前及术后左、右心房的功能、结构及血浆脑钠肽(brain natriuretic peptide,BNP)变化,探讨RFCA对心功能正常的不同起源部位室性期前收缩患者左、右心房的影响。方法收集河北医科大学第二医院住院且成功行RFCA患者62例,分为左心室来源组及右心室来源组。应用心脏超声二维斑点追踪技术观察RFCA术前及术后1 d、术后1、3、9个月的左心房前后径(left atrial diameter,LAD)、右心房射血分数(right atrial ejection fraction,RAEF)、左心房射血分数(left atrial ejection fraction,LAEF)等数据,并进行BNP检测,将相关数据进行组内及组间比较。结果两组患者术后除BNP外,各指标均较术前逐渐升高,其中术后左心房的应变(strain,S)、应变率右心室来源组明显高于左心室来源组,右心房的应变、应变率左心室来源组明显高于右心室来源组,但两组仅在不同时点间差异有统计学意义(P<0.05),组间及组间·时点间差异均无统计学意义(P>0.05)。左、右心室来源组术后BNP较术前逐渐降低。结论单纯室性期前收缩经RFCA治疗后右心室来源组左心房功能恢复较左心室来源组明显,左心室来源组右心房功能恢复较右心室来源组明显;室性期前收缩经RFCA有效治疗后可使其血浆BNP降低,在心脏超声检查心脏功能或结构改变不明显的情况下应用BNP来判断室性期前收缩患者病情严重程度和发展情况可能有一定意义。

Objective To evaluate the changes of function and structure of left and right atrium and brain natriuretic peptide(BNP)level after radiofrequency catheter ablation(RFCA)in patients with idiopathic and frequent ventricular premature contractions(VPCs)of different origins before and after operation,and to explore the impact of RFCA on left and right atria of patients with normal cardiac function and VPCs of different origins.Methods A total of 62 inpatients undergoing successful RFCA in the Second Hospital of Hebei Medical University were enrolled,and divided into left ventricle origin group and right ventricle orgin group.Two-dimensional echocardiographic speckle tracking technology was used to observe the left atrial diameter(LAD),right atrial ejection fraction(RAEF)and left atrial ejection fraction(LAEF)before and at 1 day,1 month,3 months,and 9 months after RFCA,and BNP detection was performed.The relevant data were compared within and between groups.Results The indicators in both groups were increased except BNP,as compared with those before operation.Strain(S)and strain rate(SR)of the left atrium after operation were significantly better in the right ventricle origin group than in the left ventricle origin group.The S and SR of the right atrium in the left ventricle origin group was significantly higher than those of the right ventricle origin group,however,the two groups were only statistically significant at different time points(P<0.05).No significant difference was found in interaction between groups,and time points between groups(P>0.05).After operation,BNP in right ventricle origin group and left ventricle origin group was decreased gradually.Conclusion After RFCA treatment of simple VPCs,the recovery of left atrial function of the right ventricle origin group was more obvious than that of the left ventricle origin group,and the recovery of right atrial function of the left ventricle origin group was more significant than that of the right ventricle origin group.After effective treatment of VPCs by RFCA,the plasma BNP was reduced.It may be of significance to use BNP to judge the severity and development of patients with VPCs when the cardiac function or structure changes are not obvious by echocardiography.