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目的 研究以射频消融术根治快速心律失常所致心肌病的心脏形态和功能的变化。方法 采用射频消融术(RFCA)根治10例快速心律失常所致心肌病,其中6例预激伴房颤,4例持续性交界性反复性心动过速(PJRT),对术前及术后6～12个月时患者的临床表现、心胸比率、心脏的实测与预测面积比值、二维彩色多普勒超声测量心脏形态和功能进行对比研究,并用统计学分析。结果 ①临床表现显示RFCA术后6个月症状完全消失者占40％,部分消失者占50％;心功能完全恢复者占50％。术后12个月症状完全消失者占80％,心功能恢复正常者占70％。②心胸比率及心脏实测与预测面积的比值显示,RFCA术后6个月扩大的心脏部分回缩,12个月时扩大的心脏完全恢复正常(P<0.01)。③二维彩色多普勒超声测量结果显示,RFCA术后6个月时心脏各值变化不明显,心脏收缩功能指标(LVEF、CO、CI)变化明显,而舒张功能指标变化不明显;术后12个月心腔测量各数值明显缩小,心脏舒缩功能各项指标明显改善。结论 快速心律失常所致心肌病引起的心脏扩大和功能不全具有可逆性,认识和根治这一类型心脏病的诱因-心律失常,对该类心肌病的治疗具有重要的临床价值。
Objective To study the changes of cardiac morphology and function in patients with cardiomyopathy induced by tachyarrhythmias undergoing radiofrequency catheter ablation. Methods Radiofrequency catheter ablation (RFCA) was used to treat 10 cases of cardiomyopathy induced by tachyarrhythmias, including 6 cases of pre-stimulation with atrial fibrillation and 4 cases of persistent borderline recurrent tachycardia (PJRT). Preoperative and postoperative 6 The clinical manifestations, cardiothoracic ratio, the ratio of measured and predicted heart area, and the comparison of cardiac morphology and function measured by two-dimensional color Doppler sonography at ~ 12 months were compared and statistically analyzed. Results ① The clinical manifestations showed that 40% of the symptoms were completely disappeared 6 months after RFCA, 50% of those disappeared partially, and 50% of those with complete recovery of cardiac function. After 12 months the symptoms disappeared completely accounted for 80%, normal heart function returned to 70%. The ratio of cardiothoracic and heart measured to predicted area showed that the enlarged heart partially contracted at 6 months after RFCA, and the enlarged heart recovered completely at 12 months (P <0.01). ③ The results of two-dimensional color Doppler ultrasound showed that there was no significant change of cardiac value at 6 months after RFCA, and significant changes of cardiac systolic function index (LVEF, CO, CI), but not significant change of diastolic function after operation At 12 months, the values of cardiac measurements were significantly reduced, and all indexes of cardiac systolic and diastolic function were significantly improved. Conclusions Cardiomyopathy induced by tachyarrhythmia is reversible in heart enlargement and insufficiency. It is of great clinical value to recognize and cure the predisposition of this type of heart disease - arrhythmia.