束支折返性室性心动过速射频消融后左心室功能的变化

摘要

目的 观察扩张性心肌病合并束支折返性室性心动过速(bundle branch reentry ventricular tachycardia,BBRVT)患者消融右束支后左心室功能的变化,探讨该消融方法治愈室速后对左心功能的长期影响.方法 自2007年12月至2010年2月,12例扩张性心肌病合并阵发性室速,电生理检查证实为BBRVT,标测右束支电位后予以消融,比较术前及术后12个月患者左室射血分数(left ventricular ejection fraction,LVEF)；左室舒张末内径(left ventricular end distolic diameter,LVEDD)；左室收缩末容量(left ventricular end systolic volume,LVESV)；主动脉瓣口速度时间积分(velocity time integral,VTI)；主动脉与肺动脉瓣开放时间差(QAO-QP)；纽约心功能分级(NYHA);6分钟步行距离(6 minutes walk test,6-MWT)；血浆脑钠肽前体(NT-proBNP)变化；心电图QRS宽度变化.结果 12例患者射频消融后随访1年均未再发作室速,与术前相比,术后12个月LVEF,VTI,NYHA,6-MWT均显著降低；LVEDD,LVESV,QAO-QP,NT-proBNP及QRS宽度均增加.结论 束支折返性室速消融右束支后可造成左右室间以及左室内收缩的不同步,可能是术后左室功能进一步减低的机制,但不能完全排除扩张性心肌病自身发展的影响.%Objective To observe the alteration of left ventricular function in patients with dilated cardiomyopathy (DCM) underwent right bundle branch ablation for the treatment of bundle branch reentry ventricular tachycardia ( BBRVT) , and to investigate the long term impact of this ablation method on left ventricular function. Methods All the 12 cases suffered from ventricular tachycardia with DCM were hospitalized between Dec. 2007 and Feb. 2010. Electrophysiological studies confirmed the diagnosis of BBRVT and right bundle branch ( RBB) was mapped and ablated consequently. Left ventricular ejection fraction ( LVEF) , left ventricle end diastolic diameter ( LVEDD) , left ventricular end-systolic volume (I,VESV) , aortic velocity time integral (VTI) , activation delay between aortic and pulmonary artery valve (QAO-QP) , 6 minutes walking test (6-MWT) , NT-ProBNP and width of QRS were compared between one week before the procedure and 12 months after the ablation. Results All the 12 patients were successfully ablated without recurrence of ventricular tachycardia during the one year follow-up. Compared with the above indicators of left ventricular function before the operation, LVEF, VTI, NYHA and 6-MWT were significantly decreased (P < 0. 05) , meanwhile LVEDD, LVESV, QAO-QP, NT-ProBNP and QRS width remarkably increased (P < 0. 05 ) 12 months after ablation. Conclusions Ablation of RBB in the treatment of BBRVT could induce interventricular and intraventricular desynchrony, which could be responsible for decreased left ventricular function post ablation, however, the role of natural progression of DCM could not be completely eliminated in this process.