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目的应用64排螺旋CT观察环肺静脉电隔离(CPVA)术对心房颤动患者左心房(LA)、左心耳(LAA)、LA顶部结构的影响。方法心房颤动患者共28例,行CPVA术3~14.8(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。应用64排螺旋CT测量CPVA术前、后LA[包括LA横径(LA1)、上下径(LA2)和前后径(LA3)、LA容积]、LAA(包括LAA口长径、短径和面积、LAA长度、LAA容积)、LA顶部(包括LA顶长度、距离和深度)的相关径线。结果成功组CPVA术后的LA1、LA2、LA3、LA容积、LAA口长径、LAA口面积、LAA容积、LAA长度、LA顶长度、LA顶距离术后比术前减小,术前术后分别为LA1(6.97±0.87)cm vs(6.32±0.94)cm,LA2(6.02±0.84)cm vs(5.63±0.63)cm,LA3(3.71±0.64)cm vs(3.46±0.59)cm,LA容积(83.61±25.98)cm3vs(66.11±22.84)cm3,LAA口长径(3.01±0.54)cm vs(2.64±0.62)cm,LAA口面积(4.99±1.79)cm2vs(4.11±1.94)cm2,LAA容积(11.11±4.34)cm3vs(9.59±4.82)cm3,LAA长度(3.99±0.84)cm vs(3.74±0.82)cm,LA顶长度(4.02±0.89)cm vs(3.55±0.76)cm,LA顶距离(3.90±0.88)cm vs(3.43±0.73)cm(均P<0.05);LAA口短径和LA顶深度无明显变化(P>0.05)。复发组CPVA术前、后比较,除了LA2较术前减小(6.43±1.04)cm vs(5.92±1.27)cm(P<0.05),余LA、LAA、LA顶部结构无明显变化(P>0.05)。结论成功组CPVA术后的LA、LAA、LA顶部较术前减小,即结构重构可以逆转;而复发组CPVA术前、后比较LA、LAA、LA顶部无明显变化,未出现逆重构。
Objective To observe the effect of circumferential pulmonary vein isolation (CPVA) on the structure of left atrium (LA), left atrial appendage (LAA) and LA in patients with atrial fibrillation by 64-slice spiral CT. Methods A total of 28 patients with atrial fibrillation were enrolled in this study. They were followed up for 3 ~ 14.8 (6.5 ± 3.9) months after CPVA. According to the recurrence after operation, they were divided into two groups: successful group (n = 22) and recurrent group (n = 6). LAA (including LA1, LA2 and LA3, LA volume), LAA (including LAA long diameter, short diameter and area, LAA length, LAA volume), the associated radial line at the top of the LA (including the LA top length, distance, and depth). Results The volume of LA1, LA2, LA3, LA, length of LAA, area of LAA, area of LAA, length of LAA, length of LAA, length of LA top and length of LA top in CPAP group were lower than those before operation LA1 (6.97 ± 0.87) cm vs (6.32 ± 0.94) cm, LA2 (6.02 ± 0.84) cm vs (5.63 ± 0.63) cm, LA3 (3.71 ± 0.64) cm vs 83.61 ± 25.98) cm3vs (66.11 ± 22.84) cm3, LAA long diameter (3.01 ± 0.54) cm vs (2.64 ± 0.62) cm LAA area (4.99 ± 1.79) cm2vs (4.11 ± 1.94) cm2 LAA volume ± 4.34 cm 3 vs 9.59 ± 4.82 cm 3, LAA length 3.99 ± 0.84 cm vs 3.74 ± 0.82 cm, and the length of LA top was 4.02 ± 0.89 cm vs 3.55 ± 0.76 cm, 0.88 cm vs 3.43 ± 0.73 cm respectively (all P <0.05). There was no significant change in LAA short diameter and LA depth (P> 0.05). There was no significant change in the top of LA, LAA and LA (P> 0.05), except for LA2 in the recurrence group (6.43 ± 1.04) cm vs (5.92 ± 1.27) cm ). Conclusions The top of LA, LAA and LA after CPVA in the successful group is smaller than that before the operation, that is, the structural remodeling can be reversed. In the recurrence group, there is no significant change in the top of LA, LAA and LA before and after CPVA, .