持续性心房颤动合并射血分数保留的心力衰竭患者射频消融术后右心室收缩功能的改变

Alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation and concomitant heart failure with preserved ejection fraction

目的探讨持续性心房颤动(PAF)合并射血分数保留的心力衰竭(HFpEF)患者在射频消融治疗前后右室收缩功能参数的改变。方法前瞻性入选南京医科大学第一附属医院2019年5-12月首次行射频消融治疗HFpEF-PAF的患者,分别于消融术前及术后5 d、1个月、3个月、6个月、12个月行超声心动图检查,测量分析患者右心室面积变化分数(RVFAC)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环内径(TVAD)、三尖瓣环收缩期峰值速度(TDI-S′)、右心室游离壁纵向应变(RVFLS)。术后相应时间点行常规心电图及动态心电图检查判断心房颤动是否复发。结果入选的30例患者中,因新冠肺炎疫情无法完成随访者7例,心房颤动复发4例,余19例患者完成随访,并进行右心结构及功能分析。与消融术前相比,心房颤动未复发组在术后随访各个时间点上述右心室结构及功能(RVFAC、TAPSE、TVAD、TDI-S′、RVFLS)参数明显改善(均P<0.05)。与心房颤动未复发组相比,复发组术前RVFLS、TDI-S′较低(P=0.039、0.019)。结论HFpEF-PAF患者在射频消融术后维持窦性心律能够使右室收缩功能得到改善。

Objective To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF)and concomitant heart failure with preserved ejection fraction(HFpEF).Methods The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019.Right ventricular functional parameters were measured before and 5 days,1,3,6 and 12 months after the ablation by transthoracic echocardiography,respectively,including the right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE),tricuspid annular diameter(TVAD),tricuspid annular peak systolic speed(TDI-S′)and longitudinal strain of right ventricular free wall(RVFLS).Meanwhile,routine ECG and Holter recordings were performed at each follow-up time point.Results In this study,atrial fibrillation(AF)recurrence occurred in 4 patients at the 3rd month after ablation,and 7 patients failed to follow up due to the Covid-19.Finally,19 patients were followed up for the evaluation of cardiac function after catheter ablation.Compared with pre-ablation,right ventricular structural and functional paramters(RVFAC,TAPSE,TVAD,TDI-S′,RVFLS)improved significantly at all stages of follow-up(all P<0.05).Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′at the baseline(P=0.039,P=0.019).Conclusions Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.