心房颤动导管消融术后早期左心结构及功能变化

Changes of left heart structure and function in early stage after catheter ablation of atrial fibrillation

目的探讨导管消融治疗对心房颤动患者术后早期左心结构与功能的影响。方法回顾性分析自2020年10月至2022年3月于北部战区总医院接受导管消融治疗的135例心房颤动患者的临床资料,其中,阵发性心房颤动69例(设为阵发性心房颤动组)、持续性心房颤动66例(设为持续性心房颤动组)。阵发性心房颤动患者行环肺静脉电隔离术;持续性心房颤动患者在环肺静脉电隔离术基础上,结合电生理检查附加线性消融。术前、术后次日由同1名检查者对患者进行心脏彩色多普勒超声及左心功能测定检查。比较不同心房颤动类型患者术前术后左心房结构指标(左心房直径、左心室直径、二尖瓣跨瓣压差、左心房舒张末期容积、左心房收缩末期容积)及功能指标(左心房排空分数及左心耳血流速度)的差异。结果术中,持续性心房颤动组中7例患者接受冷冻球囊消融治疗,阵发性心房颤动组为30例,两组其余患者均接受射频导管消融治疗。术前,持续性心房颤动组血清N末端脑钠肽原(NT-proBNP)、左心房直径、左心室直径、二尖瓣返流速度、二尖瓣跨瓣压差、左心房舒张末期容积、左心房收缩末期容积均大于阵发性心房颤动组,而左心室射血分数、左心房排空分数、左心耳血流速度(经胸)均小于阵发性心房颤动组,差异均有统计学意义(P<0.05);两组二尖瓣口血流速度比较,差异均无统计学意义(P>0.05)。术后次日,持续性心房颤动组二尖瓣口血流速度大于阵发性心房颤动组,而左心室射血分数、左心房排空分数小于阵发性心房颤动组,差异均有统计学意义(P<0.05);两组二尖瓣返流速度、左心耳血流速度(经胸)比较,差异无统计学意义(P>0.05);两组的其他临床指标在两组中保持着与术前一致的关系。持续性心房颤动组术后左心房排空分数及左心耳血流速度(经胸)均大于术前,差异有统计学意义(P<0.05);阵发性心房颤动组术前术后的左心房排空分数及左心耳血流速度(经胸)比较,差异无统计学意义(P>0.05)。结论导管消融术后早期,持续性心房颤动左心结构并未见明显变化,但左心房功能有所改善;阵发性心房颤动无论接受射频导管消融还是冷冻球囊消融,左心房结构及功能均未发生明显变化。

Objective To investigate the effect of catheter ablation on left heart structure and function in patients with atrial fibrillation.Methods The clinical data of 135 patients with atrial fibrillation who received catheter ablation in the General Hospital of Northern Theater Command from October 2020 to March 2022 were retrospectively analyzed,including 69 patients with paroxysmal atrial fibrillation(as paroxysmal atrial fibrillation group)and 66 patients with persistent atrial fibrillation(as persistent atrial fibrillation group).The patients with paroxysmal atrial fibrillation underwent circumferential pulmonary vein isolation.Patients with persistent atrial fibrillation were treated with annular pulmonary vein isolation combined with electrophysiological examination and linear ablation.Cardiac color Doppler ultrasound and left heart function were examined by the same examiner before and the next day after surgery.To compare the differences of left atrial structural indexes(left atrial diameter,left ventricular diameter,mitral valve cross-valve pressure difference,left atrial end-diastolic volume,left atrial end-systolic volume)and functional indexes(left atrial empty fraction and left atrial flow velocity)in patients with different types of atrial fibrillation before and after surgery.Results During the operation,7 patients in the persistent atrial fibrillation group received cryoballoon ablation,30 patients in the paroxysmal atrial fibrllation group,and the other patients in both groups received radiofrequency catheter ablation.Before operation,N-terminal pro-B-type natriuretic peptide(NT-proBNP),left atrial diameter,left ventricular diameter,mitral regurgitant velocity,mitral cross-valve pressure difference,left atrial end-diastolic volume and left atrial end-systolic volume in persistent atrial fibrillation group were all higher than those in paroxysmal atrial fibrillation group.However,left ventricular ejection fraction,left atrial emptying fraction and left atrial ear flow velocity(transthoracic)were all lower than those in paroxysmal atrial fibrillation group,with statistical significance(P<0.05).There was no significant difference in mitral orifice blood flow velocity between the two groups(P>0.05).On the next day after surgery,the mitral orifical flow velocity in the persistent atrial fibrillation group was higher than that in the paroxysmal atrial fibrillation group,while the left ventricular ejection fraction and left atrial empting fraction were lower than that in the paroxysmal atrial fibrilation group,with statistical significance(P<0.05).There was no significant difference in mitral regurgitation velocity and left atrial lobe blood flow velocity(transthoracic)between the two groups(P>0.05).Other clinical measures in both groups maintained a consistent pre-operative relationship in both groups.After operation,the left atrial emptying fraction and the left atrial ear blood flow velocity(transthoracic)in the persistent atrial fibrillation group were higher than those before surgery,and the differences were statistically significant(P<0.05).There was no significant difference in left atrial emptying fraction and left atrial ear blood flow velocity(transthoracic)before and after operation in paroxysmal atrial fibrllation group(P>0.05).Conclusion In the early period after catheter ablation,the left heart structure of persistent atrial fibrillation do not change significantly,but the left atrial function is improved.There are no significant changes in the structure and function of the left atrium in paroxysmal atrial fibrillation after radiofrequency catheter ablation or cryoballoon ablation.