左房线性消融治疗阵发性心房颤动患者术后的左房功能心超评价

摘要

目的:动态观察阵发性心房颤动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:37例阵发性房颧患者接受左房线性消融+肺静脉电隔离术,药物治疗维持窦律的患者为对照组,平均随访(10.5±4.7)个月(3～19个月).应用超声心动图观察治疗前及治疗后不同时段左房结构及功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖瓣血流频谱,以及组织多普勒测量二尖瓣环舒张晚期运动速度(Va).结果:①药物组20例成功维持窦律.消融治疗组26例成功维持窦律,9例复发;②药物治疗组长期维持窦性心律者左房容积有所变小,治疗后各个时期与治疗前比较差异无统计学意义.消融成功组术后左房容积逐渐减小,术后6个月时与术前水平比较有统计学差异,至12个月,无进一步缩小;与治疗前相比,治疗后12月左房前后径、左右径及上下径皆有统计学差异.消融后复发组6个月时未见明显变化;③消融治疗后1月,LAAEF、A-VTI、VA及AFF均与术前有统计学差异,至随访12月恢复至治疗前水平.消融治疗后心房侧的心肌组织运动速度Va皆有一定程度的降低.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;射频消融引起左房局部收缩功能降低.%Objective:The purpose of this study was to determine the effect of LA eircumferential ablation on left atrial ( LA) function in patients with paroxysmal atrial fibrillation ( PAF) after long-term follow- up. Methods : Thirty-seven consecutive patients with PAF were treated by circumferential radiofrequency pulmonary vein ablation (CPVA) and thirty-one patients were treated by drugs. The mean follow-up duration was (10. 5± 4. 7) months (range. 3 to 19 months). To evaluate the change of LA function in all patients for a long-term follow-up, we examined the LA diameters by M-mode and 2-dimensional echocardiography, mitral inllow by Doppler echocardiography before and after ablation. And we measured the velocity of mirral annulus motion (Va) in late diastolic phase by tissue Doppler image. Results: ① Twenty patients (64. 52 ％ ) out of thirty-one in control group mainain sinus thythm. Twenty-six (70. 27 ％ ) patients out of thirty-seven in CPVA group were successfully treated, and nine patients failed; ②After long-term maintenance of sinus thythm, the left atrial volume has become smaller. No statistical significance in different periods after treatment compared with before treatment in control group. Six months after ablation. the left atrial volume was significantly smaller in patients who hadsinus conversion by the RF procedure, no further reduction 12 months after the treatment. The left atrial diametcr was significantly smaller in patients who remained in sinus thythm. In contrast, in patients with recurrences of AF, LA dimension and left atrial volume were not changed;③One month after ablation, the LAAEF, A-VTl, VA and AFF decreased and recovered 12 months later. The Va significantly decrease after RF ablation. Conclusion:Circumferential radiofrequencypulmonary vein ablation for PAF is effective. This study demonstrates reverse morphological remodeling of the LA after restoration ot sinus thythm by ablation and no difference in patients with AF recurrence. LA catheter ablation results in decreased LA local systolic function.