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目的:探讨环肺静脉隔离术对阵发性心房颤动(Af)患者左心房大小和功能的影响。方法:28例阵发性Af患者择期行环肺静脉隔离术,根据Af复发与否分为复发组(5例)和未复发组(23例);同期选择窦性心律患者30例作为对照组。应用超声心动图对所有患者在窦性心律下于术前、术后24h、1个月和3个月时测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、二尖瓣环晚期运动峰值速度(A峰)、肺静脉收缩期波(S峰)、舒张期波(D峰)、心房血流逆向波(PVa峰),并计算左心房射血分数(LAEF)。结果:①左心房大小:复发组和未复发组患者消融术前LAVmax和LAVmin均较对照组增加(均P<0.05),在术后24hLAVmin均增加(均P<0.01),LAVmax无明显变化;未复发组术后1个月时LAVmax、LAVmin均减小至正常(均P<0.05),术后3个月时未再进一步减小,而复发组术后1个月和3个月恢复至术前大小。②左心房功能:复发组和未复发组消融术前LAEF和A峰值均较对照组降低(均P<0.05),术后24h左心房功能指标均较术前明显降低(均P<0.05);术后1个月时复发组和未复发组左心房功能指标较术后24h均明显增加(均P<0.01),2组PVa峰、S峰和D峰值均恢复至术前正常水平(均P<0.05),LAEF和A峰在未复发组增加至正常水平(P<0.05),而在复发组仅恢复至术前水平;术后3个月时左心房功能指标较术后1个月时均未再有明显变化。结论:环肺静脉隔离术可以逆转阵发性Af造成的左心房大小和功能异常,而且长期对左心房大小和功能无负面影响。
Objective: To investigate the effect of circumferential pulmonary vein isolation on the size and function of left atrium in patients with paroxysmal atrial fibrillation (Af). Methods: 28 cases of patients with paroxysmal Af were treated with circumferential pulmonary vein isolation. According to the recurrence Af, they were divided into recurrence group (n = 5) and non-recurrent group (n = 23). Thirty patients with sinus rhythm were selected as the control group. The left atrium volume (LAVmax), left atrium minimum volume (LAVmin), late mitral annulus was measured by echocardiography in sinus rhythm before operation, 24h, 1 month and 3 months after operation. Peak A velocity, S peak, D peak and PVa peak were calculated. Left atrial ejection fraction (LAEF) was calculated. Results: ① Left atrial size: LAVmax and LAVmin were significantly increased in both recurrent and non-recurrent groups compared with those in control group (all P <0.05) and increased at 24 h postoperatively (all P <0.01) LAVmax and LAVmin in non-recurrent group decreased to normal at 1 month after operation (all P <0.05), but did not decrease further at 3 months after operation, while recurrent group recovered to 1 and 3 months after operation Preoperative size. Left atrial function: The LAEF and A peak before ablation were lower than those in the control group (P <0.05), and the indexes of atrial function at 24 h after operation were significantly lower than those before operation (all P <0.05). At 1 month after operation, left atrial function was significantly increased in both recurrent and non-recurrent groups (all P <0.01), PVa peak, S peak and D peak returned to preoperative normal levels (P <0.05). The LAEF and A peak increased to the normal level in the non-relapse group (P <0.05), but recovered to the preoperative level in the relapse group. The left atrial function index at 3 months after operation was significantly higher than that at 1 month No significant changes have been made. CONCLUSIONS: Circumferential pulmonary veno-venous isolation can reverse the size and dysfunction of left atrium caused by paroxysmal Af and have no negative effect on the size and function of the left atrium for long periods.