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目的探讨不同的射频消融术式对阵发性心房颤动(PAF)患者左房功能的远期效应。方法65例PAF患者分别接受节段性肺静脉隔离术(SPVI组,27例)和左房线性消融术(CPVA组,38例),术后随访6-27个月,平均为(14．9±5．5)个月,应用超声心动图观察消融成功者手术前、后左房功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖辦血流频谱,以及组织多普勒测量二尖辦环舒张晚期运动速度(Va)。结果SPVI组,随访6-28个月,平均为(20．8±4．3)个月,18例(66．7％)治疗成功,其中4例仍需口服乙胺碘肤酮,另有8例复发,1例失访。CPVA组随访,6-19个月,平均为(13．3±2．6)个月,28例(73．7％)治疗成功,其中3例仍需口服乙胺碘肤酮,另有9例复发,1例失访,1例患者于术中出现少量心包积液,后自行吸收。所有患者中无血栓栓塞、肺静脉狭窄和左房食管漏等严重并发症发生。消融治疗成功的两组患者术前左房大小相似,平均值超过正常水平(LAAPD>40 mm),术后LAAPD、LAMD和LASID都减小,至随访终点时CPVA组LAAPD和LAMD比术前明显减小(P值均<0．01),两组患者术后左房内径的差异无统计学意义(P值均>0．05)。消融成功者左房收缩功能好转,消融治疗成功的两组患者术前二尖瓣血流频谱VA、A-VTI、AFF和AEF无明显差异,长期随访见左房收缩功能好转。两组患者VA和A-VTI都较术前增加(P值均<0．05), SPVI组AFF消融前、后差异有统计学意义(P<0．05),而CPVA组差异无统计学意义(P>0．05),两组AEF消融前、后差异均无统计学意义(P>0．05)。两组术后二尖瓣血流参数值的差异无统计学意义(P>0．05),而PW-TDI测得术后两组患者二尖瓣环运动曲线上Va的差异有统计学意义(P<0．05),SPVI组为(99．39±1．93) cm／s,CPVA组为(98．33±1．05) cm／s,两组差异有统计学意义(P<0．05)。结论射频消融术是治疗PAF的有效方法,长期随访显示,消融成功者左房结构和收缩功能好转,但左房线性消融术可能对左房局部收缩功能有影响。
Objective To investigate the long-term effects of different radiofrequency ablation procedures on left atrial function in patients with paroxysmal atrial fibrillation (PAF). Methods Sixty-five PAF patients underwent segmental pulmonary vein isolation (SPVI group, n = 27) and left atrium linear ablation (CPVA group, n = 38). All patients were followed up for 6-27 months with an average of (14.9 ± 5.5) months, the changes of left atrium function before and after ablation were observed by echocardiography, left atrium diameter was measured by M-mode and two-dimensional ultrasound, Doppler flow spectrum was measured by Doppler, and tissue Doppler measurement of mitral annulus late diastolic velocity (Va). Results The SPVI group was followed up for 6-28 months with an average of (20.8 ± 4.3) months and 18 cases (66.7%) were successfully treated. Ethidium iodide was administered to 4 patients in the SPVI group and another 8 patients relapsed, 1 patient lost. The CPVA group was followed up for 6-19 months with an average of (13.3 ± 2.6) months and 28 cases (73.7%) were successfully treated. Ethidium iodide was administered to 3 patients and 9 One case of recurrence, one case of lost follow-up, a case of a small amount of pericardial effusion occurred during surgery, self-absorption. In all patients, no serious complications such as thromboembolism, pulmonary vein stenosis and left atrial esophageal leakage occurred. The mean preoperative left atrial dimensions were similar in patients with successful ablation, with an average of more than normal (LAAPD> 40 mm). LAAPD, LAMD, and LASID decreased after surgery. LAAPD and LAMD in the CPVA group were significantly lower at the end of follow-up than before surgery (P <0.01). There was no significant difference in left atrium diameter between the two groups (P> 0.05). Successful ablation of left atrial systolic function improved, successful ablation of the two groups of patients preoperative mitral flow VA, A-VTI, AFF and AEF no significant difference in long-term follow-up of left atrial systolic function improved. VA and A-VTI in both groups were significantly higher than those before operation (all P <0.05). There was significant difference between before and after AFF ablation in SPVI group (P <0.05), but no difference in CPVA group Significance (P> 0.05). There was no significant difference between the two groups before and after ablation (P> 0.05). There was no significant difference in the values of postoperative mitral flow parameters between the two groups (P> 0.05), while there was a significant difference in Va between the two groups after PW-TDI (99.39 ± 1.93) cm / s in SPVI group and (98.33 ± 1.05) cm / s in CPVA group (P <0.05), the difference between the two groups was statistically significant (P < 0.05). Conclusion Radiofrequency catheter ablation is an effective method for the treatment of PAF. Long-term follow-up shows that left atrial structure and systolic function improve after successful ablation, but left-atrium linear ablation may have an effect on local systolic function of the left atrium.