环肺静脉隔离联合左心房顶部消融治疗心房颤动的效果

Effect of Circumferential Pulmonary Vein Isolation Combined with Left Atrial Apex Ablation for Atrial Fibrillation

目的分析环肺静脉隔离(CPVI)联合左心房顶部消融治疗心房颤动的效果以及对左室同步性、收缩功能、血清热休克蛋白27(HSP27)、成纤维细胞生长因子-21(FGF-21)的影响。方法选取郑州大学第二附属医院2020年4月至2021年9月收治的心房颤动患者94例作为研究对象,依据手术方案分为研究组与对照组,各47例。对照组接受CPVI治疗,研究组接受CPVI联合左心房顶部消融术,对比两组手术状况(手术时间、X线曝光时间)以及术前、术后3个月、术后6个月左室收缩功能[二尖瓣开放时心房收缩时左房最大容积(LAV)、左房射血力(LAF)]、左室同步性[心房舒张期心房应变达峰时间标准差(SDa)、心室收缩期心房应变达峰时间标准差(SDs)]、HSP27、FGF-21水平。结果术后3个月、6个月研究组LAV、SDs、SDa低于对照组,LAF高于对照组(P<0.05);术后3个月、6个月研究组血清HSP27、FGF-21水平低于对照组(P<0.05)。结论CPVI联合左心房顶部消融术治疗心房颤动患者,可增强心功能,改善心房纤维化程度,减轻应激反应。

Objective To analyze the effect of circumferential pulmonary vein isolation(CPVI)combined with left atrial apex ablation for atrial fibrillation and the effect on left ventricular synchronization,systolic function,serum heat shock protein 27(HSP27),and fibroblast growth factor-21(FGF-21).Methods A total of 94 patients with atrial fibrillation admitted to the Second Affiliated Hospital of Zhengzhou University between April 2020 and September 2021 were selected as study subjects and divided into study group and control group according to surgical protocols,with 47 cases in each group.The control group was treated with CPVI and the study group was treated with CPVI combined with left atrial apex ablation,and the two groups were compared in terms of surgical status(operative time,length of X-ray exposure)and left ventricular systolic function[maximum left atrial volume(LAV)during atrial systole at mitral valve opening,left atrial ejection force(LAF)],left ventricular synchronization[standard deviation of atrial strain peaking time during atrial diastole(SDa),standard deviation of atrial strain peak time during ventricular systole(SDs)],serum HSP27 and FGF-21 levels.Results LAV,SDs and SDa in the study group were lower than those in the control group and LAF was higher than that in the control group at 3 and 6 months postoperatively(P<0.05).Serum HSP27 and FGF-21 levels in the study group were lower than those in the control group at 3 and 6 months postoperatively(P<0.05).Conclusion CPVI combined with left atrial apex ablation for patients with atrial fibrillation enhances cardiac function,improves atrial fibrosis,and reduces the stress response.