RT3DE对心房颤动RFCA后左心房容积和功能的评价

摘要

Objective To evaluate the left atrial volumes and function before and after operation in patients with radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) by using real-time 3-dimensional echocardiography (RT3DE),and to observe its feasibility.Methods The left ventricular ejection fraction (LVEF) by pulsed-wave doppler,peak velocity in early relaxing period (E),peak systolic flow velocity (A) and E/A value in 60 patients with AF treated with RFCA were detected before operation,1 d and 3 months after operation; LA maximum volume (LAVmax),LA minimum volume (LAVmin) and volume before atrial active contraction (LAVpre) were detected by RT3DE examination,and LA ejection fraction (LAEF),LA passive ejection fraction (LAEFp),LA active ejection fraction (LAEFa) and LA expansion index (LAres) were also calculated.The patients were divided into successful RFCA group (group A,n =47) and AF recurrence group (group B,n =13),and index changes in the two groups were compared.Results There were no significant differences in LVEF,E,A and E/A before operation,1 d and 3 months after operation between any of the two groups and in any one group (P ＞ 0.05).Indexes of LAVmax,LAVmin and LAVpre 3 months after operation in group A were significantly lower than those before and 1 d after operation (P ＜ 0.05) ; the differences of LAVmax at the same time in the two groups were statistically significant(P ＜0.05),and the differences of LAVmin and LAVpre 3 months after operation in the two groups were also statistically significant (P ＜ 0.05) ; indexes of LAEF,LAEFa and LAres in group A were obviously elevated 3 months after operation,while those in group B were decreased,and the differences between the two groups showed statistical significance (P ＜0.05),The differences in group A in LAEF,LAEFa and LAres between 3 months after operation with those before and 1 d after operation were statistical significance (P ＜ 0.05).Conclusion A significant reverse remodeling and functional improvement in the left atrium can be found in AF patients with successful RFCA.RT3DE can accurately and quickly evaluate left atrial (LA) volume and function,which may be used as observation index for course of disease,curative effect and prognosis in patients with AF.%目的 应用实时三维超声心动图(realtime three-dimensional echocardiography,RT3DE)对心房颤动(AF)患者射频消融术(RFCA)术前及术后左心房容积和功能进行定量评价,观察其可行性.方法 选择我院AF并行RFCA治疗的60例,分别于RFCA术前、术后ld及术后3个月行脉冲波多普勒记录左心室射血分数(LVEF)、舒张早期峰值速度(E)、收缩期峰值速度(A)及E/A;行RT3DE检查,测量左心房最大容积(LAVmax)、最小容积(LAVmin)及收缩前容积(LAVpre),同时计算左心房射血分数(LAEF)、左心房被动射血分数(LAEFp)、左心房主动射血分数(LAEFa)及左心房扩张指数(LAres).60例分为RFCA成功组(47例)和AF复发组(13例),比较上述参数变化情况.结果 两组术前、术后ld及术后3个月LVEF、E、A及E/A组间及组内各时点比较差异均无统计学意义(P＞0.05).与术前、术后ld比较,术后3个月RFCA成功组LAVmax、LAVmin、LAVpre明显降低,差异有统计学意义(P＜0.05)；两组相同时点LAVmax比较差异均有统计学意义(P＜0.05),术后3个月两组LAVmin、LAVpre比较差异均有统计学意义(P＜0.05)；术后3个月RFCA成功组LAEF、LAEFa、LAres明显升高,而AF复发组反而降低,组间比较差异有统计学意义(P＜0.05),与术前及术后1d比较差异亦有统计学意义(P＜0.05).结论 RFCA成功的AF患者左心房逆重构,功能明显改善.RT3DE评价AF患者左心房容积和功能准确、快速,可作为AF患者病程监测、疗效观察及预后判断的观察指标.