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目的动态观察阵发性心房颤动(房颤)患者射频消融术前及消融后不同时段左房结构和功能的变化,探讨射频消融术对左房功能的影响及其临床意义。方法: 28例阵发性房颤患者接受左房线性消融+肺静脉电隔离术,其中男18例,女10例,平均年龄(61．3±8．8)岁(46- 75岁),术前房颤持续时间(4．5±3．3)年(0．5- 13年),14例无基础心脏病,12例有高血压,2例有冠心病。分别于术前、术后1周内、1、6及12个月以上时应用心脏超声观察左房结构和功能随时间变化的过程。观察左房前后径、左右径和上下径的变化,测量左房最大容积、最小容积和心房收缩前容积,计算左房主动射血分数(LAAEF),脉冲多普勒测量二尖辦E波、A波峰速度(VE、VA)和速度时间积分(E-VTI、A-VTI),计算左房充盈分数(AFF)和左房射血力(AEF)。结果①28例患者术后平均随访(10．5±4．7)个月(3-19个月),随访终点时20例无复发,8例复发:术后3个月时,10例患者因始终无AF发作而停抗心律失常药;6个月时,10例患者仍需口服抗心律失常药物,AF发作较术前减少70％,其中6例为普罗帕酮,4例服用胺碘酮;另有8例患者服药过程中房颤发作仍频繁,其中5例合用胺碘酮和美托洛尔,1例合用普罗帕酮和美托洛尔,2例单纯用美托洛尔控制心室率。②术后消融成功者左房内径和容积逐渐缩小,而复发者无明显变化;1周内消融组患者左房大小均未见明显变化,之后因临床转归的不同,各自呈现不同的变化趋势:消融成功组左房逐渐变小,6和12个月时左房前后径和左右径与术前比较差异有统计学意义(P<0．05),左房上下径的P值为0．05,12个月时左房最大容积和最小容积较术前明显减小(P<0．05);而复发组左房内径和容积均无明显变化。③左房收缩功能因消融而部分丧失,VA和A-VTI在术后1周内进一步减小,术后逐渐恢复,消融成功者1个月时逐渐好转,至术后12个月较术前有明显增加(P<0．05);LAAEF、AFF和AEF同样在术后1周内降低,以后随时间的推移逐渐恢复;但复发者至随访末期仍低于术前水平。结论左房线性消融是治疗阵发性房颤的有效方法,消融成功者可一定程度逆转左房结构重构,复发者无明显变化;成功组左房收缩功能在术后1周内降低,但长期转归佳,而复发者左房收缩功能仍低于术前。
Objective To observe the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation (AF) before radiofrequency ablation and at different time after radiofrequency ablation, and to explore the effect of radiofrequency catheter ablation on left atrial function and its clinical significance. Methods: Twenty-eight patients with paroxysmal atrial fibrillation underwent left atrium linear ablation and pulmonary vein isolation. There were 18 males and 10 females with a mean age of (61.3 ± 8.8) years (46-75 years) The duration of anterior fibrillation was 4.5 ± 3.3 years (0.5-13 years), 14 had no underlying heart disease, 12 had hypertension, and 2 had coronary heart disease. The changes of left atrial structure and function over time were observed with echocardiography before surgery, within 1 week and 1, 6 and 12 months respectively. Left and right anteroposterior diameter, left and right diameter and upper and lower diameter of the left atrium were measured to measure left atrium maximum volume, minimum volume and atrial volume, LAAEF was calculated, A peak velocity (VE, VA) and velocity-time integral (E-VTI, A-VTI) were calculated for left atrial appendage (AFF) and left atrial ejection (AEF). Results ①The average follow-up of 28 patients was (10.5 ± 4.7) months (3-19 months). No recurrence was found in 20 patients and 8 patients relapsed at the end of follow-up. At 3 months after operation, 10 patients There was always no AF episode to stop antiarrhythmic drugs. At 6 months, 10 patients were still required to take oral antiarrhythmic drugs. AF seizure was reduced by 70% compared with that before surgery, including 6 propafenone and 4 amiodarone In another 8 patients, the onset of atrial fibrillation was still frequent. Among them, 5 patients were treated with amiodarone and metoprolol, 1 patient was propafenone and metoprolol, and 2 patients were treated with metoprolol alone to control ventricular rate. ②After successful ablation, left atrium diameter and volume gradually decreased, while no significant changes in relapse; within 1 week ablation group, there was no significant change in the size of left atrium, and then due to the different clinical outcomes, showing different trends : Left atrium was gradually smaller in successful ablation group. There was a significant difference in left and right anteroposterior diameter and left and right diameter at 6 and 12 months (P <0.05). P value of left and right atrium was 0. 05,12 months left atrial maximum volume and minimum volume was significantly reduced compared with preoperative (P <0.05); while the recurrence of left atrium diameter and volume were no significant changes. (3) Left atrial systolic function was partially lost due to ablation, VA and A-VTI decreased further within 1 week after operation, and gradually recovered after operation. The patients with successful ablation gradually improved at 1 month, (P <0.05). LAAEF, AFF and AEF also decreased within 1 week after operation and gradually recovered with the passage of time. However, the relapse rate was still lower than the preoperative level at the end of follow-up. Conclusions Linear ablation of left atrium is an effective method for the treatment of paroxysmal atrial fibrillation. Successful ablation of the left atrium can reverse the left atrial structure remodeling to a certain degree without any significant changes in recurrence. In the successful group, the left atrial systolic function decreases within 1 week after operation Good long-term prognosis, and recurrence of left atrial systolic function is still lower than preoperative.