环肺静脉电隔离术对心房颤动患者左心房、左心耳、左心房顶部结构的影响

摘要

目的 应用64排螺旋CT观察环肺静脉电隔离(CPVA)术对心房颤动患者左心房(LA)、左心耳(LAA)、LA顶部结构的影响.方法 心房颤动患者共28例,行CPVA术3～14.8(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例).应用64排螺旋CT测量CPVA术前、后LA[包括LA横径(LA1)、上下径(LA2)和前后径(LA3)、LA客积]、LAA(包括LAA口长径、短径和面积、LAA长度、LAA容积)、LA顶部(包括LA顶长度、距离和深度)的相关径线.结果 成功组CPVA术后的LA1、LA2、LA3、LA客积、LAA口长径、LAA口面积、LAA容积、LAA长度、LA项长度、LA顶距离术后比术前减小,术前术后分别为LA1(6.97±0.87)crn vs(6.32±0.94)cm,LA2(6.02±0.84)cm vs(5.63±0.63)cm,LA3(3.71±0.64)cm vs(3.46±0.59)cm,LA客积(83.61±25.98)cm3vs(66.11±22.84)cm3,LAA口长径(3.01±0.54)cm vs(2.64±0.62)cm,LAA口面积(4.99士1.79)cm2 vs(4.11士1.94)cm2,LAA容积(11.11±4.34)cm3 vs(9.59±4.82)cm3,LAA长度(3.99±0.84)cm vs(3.74±0.82)cm,LA顶长度(4.02±0.89)cm vs(3.55±0.76)cm,LA项距离(3.90±0.88)com vs(3.43±0.73)cm(均P0.05).复发组CPVA术前、后比较,除了LA2较术前减小(6.43±1.04)cm vs(5.92±1.27)cm(P0.05).结论 成功组CPVA术后的LA、LAA、LA顶部较术前减小,即结构重构可以逆转;而复发组CPVA术前、后比较LA、LAA、LA顶部无明显变化,未出现逆重构.%Objective To observe the effect of circumferential pulmonary vein ablation (CPVA) for atrial fibrillation(AF) on the structure of left atrium(LA), left atrial appendage(LAA) and left atrial(LA) roof using 64-slice multidector computed tomography(CT).Methods 28 patients with AF who underwent CPVA were followed-up after 3-14.8(6.5 ± 3.9) months.Then, they were divided into successful group (22 patients) and recurrence group (6 patients) according to the recurrence of AF.The sizes of LA including the transverse diameter of LA (LA1), the superoinferior diameter of LA(LA2), the anteroposterior diameter of LA(LA3), LA volume, LAA including the long diameter, short diameter and area of LAA orifice,the length of LAA, LAA volume, and LA roof including the length, distance and depth of LA roof were measured before and after CPVA using 64-slice multidector CT.Results In successful group,compared with preablation after CPVA,LAl decreased (6.97±0.87) cm vs (6.32±0.94) cm;LA2 decreased,(6.02±0.84) cm vs (5.63±0.63) cm,LA3 decreased,(3.71±0.64) cm vs (3.46±0.59) cm,LA volume decreased,(83.61±25.98) cm3 vs (66.11±22.84) cm3 ,the long diameter of LAA orifice decreased (3.01±0.54) cm vs (2.64±0.62) cm, the area of LAA orifice decreased, (4.99 ± 1.79) cm2 vs (4.11 ± 1.94) cm2, LAA volume decreased, (11.11±4.34) cm3 vs (9.59±4.82) cm3 ,the length of LAA decreased, (3.99±0.84) cm vs (3.74±0.82) cm; the length of LA roof decreased, (4.02 ± 0.89 ) cm vs ( 3.55 ± 0.76 ) cm, the distance of LA roof decreased, ( 3.90 ± 0.88) cm vs ( 3.45±0.73)cm(all P ＜0.05).However,there was no significant change in the short diameter of LAA orifice and the depth of LA roof( P ＞0.05).In recurrence group, compared with preablation after CPVA, LA, LAA and LA roof showed no significant change ( P ＞ 0.05 ) excepted LA2 decreased, (6.43 ± 1.04) cm vs (5.92 ± 1.27 ) cm ( P ＜ 0.05).Conclusion In successful group, compared with preablation after CPVA, LA, LAA, and LA roof decreased.Structural remodeling could be reversible.However, in recurrence group,LA, LAA,and LA roof showed no significant change before and after CPVA;reverse remodeling could not be shown.