房颤患者射频消融术前后运动心肺功能变化的初探

Clinical study of the changes of cardiopulmonary function in patients with atrial fibrillation after surgi⁃cal radio frequency ablation

目的:探讨心肺运动试验(cardiopulmonary exercise testing,CPET)对外科射频消融(radiofrequency ablation,RA)治疗持续性房颤患者整体功能变化的评估作用。方法:选取2017年1月—2021年12月中国科学院阜外医院进行RA术的房颤患者26例,于术前和术后3个月行CPET检查,按照Harbor-UCLA医学中心标准连续递增功率方案完成症状限制性极限运动,分析比较静息、热身、无氧阈(anerobic threshold,AT)、峰值和恢复期的循环指标及呼吸指标。结果:RA术后所有患者安静及运动心电图的房颤波形均消失,CPET静息和运动心电图显示22例为窦性心律,4例为房扑(2∶1或3∶1下传)。26例房颤患者RA术后3个月行CPET检查,峰值氧脉搏(peak VO_(2)/HR)较术前显著提高[(91.91±21.24)%pred比(71.25±18.98)%pred;(P<0.01)];峰值摄氧量(peak VO_(2))和AT较术前显著下降[peak VO_(2):(61.60±9.76)%pred比(69.00±8.11)%pred;(P<0.01)],[AT:(67.62±1.83)%pred比(74.24±12.66)%pred;(P<0.05)];摄氧通气效率峰值平台、二氧化碳排出通气比值最低值和二氧化碳排出通气斜率未见显著差异。RA术前后CPET不同功能状态的比较:热身、AT、峰值和恢复期VO_(2)/HR较术前显著升高(P<0.05);5个功能状态的心率较术前显著下降(P<0.05);峰值和恢复期分钟通气量较术前显著下降(P<0.01—0.05);静息、AT、峰值和恢复期潮气量较术前显著下降(P<0.05)。结论:房颤RA术可有效提高房颤患者peak VO_(2)/HR,但peak VO_(2)和AT均较术前下降,提示术后应尽早实施运动康复训练以提高心肺整体功能。

Objective:To investigate the role of cardiopulmonary exercise testing(CPET)in the evaluation of the changes of the holistic function of patients with atrial fibrillation(AF)disease after surgical radio frequency ablation(RA).Method:From January 2017 to December 2021,we enrolled 26 patients with AF who underwent RA in Fuwai Hospital and conducted CPET examination before and 3 months after surgery.According to standard continuously increasing power scheme of UCLA Medical Center,the circulation and respiration indexes at rest,warm-up,and anerobic threshold(AT),peak and recovery stages were derived by system software and analyzed.Result:The AF waveform of ECG in all 26 patients after RA surgery disappeared.The ECG of 22 patients Harshowedsinus rhythm, and 4 patients showed atrial flutter with 2∶1 or 3∶1 atrial ventricular conduction. 3months after RA surgery,peak O_(2) pulse was significantly increased [(91.91±21.24)%pred vs (71.25±18.98)%pred;(P<0.01)];PeakVO_(2) and AT were significantly decreased [peak VO_(2):(61.60±9.76)%pre vs (69.00±8.11)%pred;(P<0.01)],[AT:(67.62±1.83)%pred vs (74.24±12.66)%pred;(P<0.05)];Oxygen uptake efficiency platform(OUEP),lowest of carbon dioxide output ventilation ratio (lowest VE/VCO_(2)) and carbon dioxide outputventilation slope (VE/VCO_(2) slope) were not affected. After the RA surgery,O_(2) pulse at warm-up,AT,peakand recovery were significantly increased(P<0.05);Heart rate (HR) during all the five stages of CPET weresignificantly decreased(P<0.05);Minute ventilation (VE) at peak and recovery were significantly decreased(P<0.01—0.05);Tidal volume (VT) at rest,AT,peak and recovery were significantly decreased(P<0.05).Conclusion:The patients with AF after RA surgery have obvious improvement in O_(2) pulse,but decrease inpeakVO_(2) and AT,indicating the important role of exercise training in improving holistic function of patientswith AF after RA surgery.