导管射频消融术对阵发性心房颤动患者心肌酶及心功能的影响

Influence of radiofrequency catheter ablation on myocardial enzymes and heart function in patients with paroxysmal atrial fibrillation

目的 探讨导管射频消融术对阵发性房颤患者心肌酶及心功能的影响。方法 选择2019年3月至2020年9月因阵发性房颤入住阜外华中心血管病医院的患者120例为研究对象,根据随机数表法分为射频消融组(A组)和对照组(B组),每组60例;A组给予导管射频消融治疗,B组给予规范药物治疗,即控制心室率及抗凝药物;A组于术前、术后2 h、术后48 h,B组服药前,服药后2 h和48 h测定心肌酶谱,主要测定肌酸激酶同工酶(CK-MB),肌钙蛋白(cTnI)。A组于术前及术后6个月,B组于服药前,服药后6个月行心脏彩超+左心功能测定检查,主要测定左房前后径(LAAPD),左室舒张末内径(LVESD),左室射血分数(LVEF)。结果 A组术后2 h心肌酶较术前升高(P<0.01),术后48 h心肌酶与术前相比无统计学差异(P>0.05),术后6个月A组LAAPD、LVESD较术前减小,LVEF较术前有所提高(P<0.05),与B组比较,A组LAAPD、LVESD减小,LVEF提高(P<0.05)。结论 导管射频消融是治疗房颤的有效手段,可能引起心肌酶的短暂升高,但48 h后明显下降,且6个月复查心功能有所改善。

Objective To discuss the influence of radiofrequency catheter ablation(RFCA) on myocardial enzymes and heart function in patients with paroxysmal atrial fibrillation(PAF). Methods The patients(n=120)hospitalized due to PAF were chosen from Fuwai Central China Hospital of Cardiovascular Medicine from Mar.2019 to Sept. 2020, and divided, according to random digital table, into RFCA group(group A), and control group(group B, each n=60). The group A was given RFCA therapy and group B was given standard drugs including drugs for controlling ventricular rate and anticoagulant. The myocardial enzyme spectra, mainly including creatine kinaseMB isoenzyme(CK-MB) and cardiac troponin(cTnI) were detected in group A before and 2 h and 48 h after RFCA,and in group B before and 2 h and 48 h after drug administration. The examinations of cardiac color ultrasound and left ventricular function were performed, mainly including left atrial anteroposterior diameter(LAAPD), left ventricular end-systolic diameter(LVESD) and left ventricular ejection fraction(LVEF) in group A before and 6months after RFCA and in group B before and 6 months after drug administration. Results The myocardial enzymes increased(P<0.01) in group A 2 h after RFCA, and there was no statistical difference in myocardial enzymes 48 h after RFCA compared with those before RFCA(P>0.05). LAAPD and LVESD decreased and LVEF increased in group A 6 months after RFCA(P<0.05). LAAPD and LVESD decreased and LVEF increased in group A compared with group B(P<0.05). Conclusion RFCA is an effective therapy for atrial fibrillation. Although it may cause a transient elevation of myocardial enzymes, which significantly decrease after 48 h, and the heart shranks and heart function is improved after 6 months.