【作者】 许海侠；

【导师】 惠杰；

【作者基本信息】 苏州大学 ， 心血管病学， 2011， 硕士

【摘要】 目的:探讨心房颤动(房颤)患者经导管射频消融术后,其左心房(左房)结构和功能的变化。方法:选择29例房颤患者(房颤组),行环肺静脉电隔离术,部分加线消融,达到完全肺静脉电解剖隔离。其中男21例,女8例,平均年龄59.8±8.7(40～73)岁,合并高血压5例。选择同期非心房颤动就诊者30例(对照组)与房颤组术前比较,其中男18例,女12例,平均年龄60.0±8.3(42～69)岁,合并高血压7例。应用超声心动图对所有病例在窦性心律下(1例持续性房颤除外),分别于术前和术后24h、1个月、3个月测量以下参数:①左房结构:左房前后径(LAAPD)、左房上下径(LASID)、左房左右径(LAMD)、左房最大容积(LAVmax)、左房最小容积(LAVmin);②左房功能:多切面测定二尖瓣环舒张早期(E峰)和晚期运动峰值速度(A峰),肺静脉收缩期波(S峰)、舒张期波(D峰)、心房血流逆向波(PVa峰),并计算左房射血分数(LAEF)。结果:射频消融术后维持窦性心律23例(非复发组),仍有房颤发作6例(复发组)。超声心动图检查,术前:房颤组左房内径、左房容积均大于对照组(P﹤0.05),A峰及LAEF均较对照组减小(P﹤0.05),肺静脉血流频谱与对照组比较,差异无统计学意义(P﹥0.05);复发组与非复发组术前各项基本资料比较,差异无统计学意义(P﹥0.05)。所有患者术后均完成3个月的随访,①术后24h:复发组及非复发组的LAVmin较术前增大(P﹤0.05),二尖瓣、肺静脉血流频谱值及LAEF较术前减小(P﹤0.05),左房内径及LAVmax与术前比较,差异无统计学意义(P﹥0.05)。②术后1个月:未复发组左房内径及左房容积较术前减小(P﹤0.05),A峰及LAEF较术前增大(P﹤0.05),LAVmin较术后24h明显减小(P﹤0.01);复发组左房结构及功能与术前比较,差异无统计学意义(P﹥0.05),LAVmin较术后24h明显减小(P﹤0.01);两组内左房功能均较术后24h明显改善(P﹤0.01);与复发组比较,未复发组左房内径及容积减小(P﹤0.05),A峰及LAEF增加(P﹤0.05)。③术后3个月:未复发组左房内径及容积较术前减小(P﹤0.05),A峰及LAEF较术前增加(P﹤0.05),左房结构及功能与术后1月比较,差异无统计学意义(P﹥0.05);复发组左房结构及功能与术前及术后1月比较,差异无统计学意义(P﹥0.05);与复发组比较,未复发组左房内径及容积减小(P﹤0.05),A峰及LAEF增加(P﹤0.05)。结论:射频消融是治疗房颤的一种有效方法,消融术后维持窦性心律者,可逆转左房结构及改善左房功能,而复发者左房结构及功能变化不明显。更多还原

【Abstract】 Objective: TO recognize the left atrial(LA) structure and function changes in the atrial fibrillation(AF) patients after radiorequency catheter ablation.Methods: 29 cases of atrial fibrillation(AF) patients(AF group) received circumferential pulmonary vein ablation, some of them added line ablation, to achieve complete pulmonary vein isolation anatomy. Among them there were 21 male, and 8 female;the average age was 59.8±8.7(40～73)years old and 5 cases were complicated with hypertension. Slected 30 cases non-AF patiengts(control group)who saw a doctor to our hospital to compare with preoperative atrial fibrillation. Among them there were 18 males and 12 females, mean age 60.0±8.3 (42～69) years old, with hypertension 7 cases. Using the echocardiography, we observe the following parameters in all cases in sinus rhythm (except for 1 case persistent atrial fibrillation) in preoperative ablation and 24h, 1 month, 3 months after ablation respectively:①Left atrial structure: left atrial anteroposterior dimension (LAAPD), left atrial inferosuperior dimension (LASID), left atrial mediolateral dimension (LAMD), left atrial maximum volume(LAVmax), left atrial minimum volume (LAVmin);②Left atrial function: Mitral annulus early(E peak) and late diastolic peak velocity(A peak) , pulmonary vein systolic wave (S peak), pulmonary vein diastolic wave (S peak) and atrial reverse flow wave (PVa peak) were assessed, and calculate the left atrial ejection fraction (LAEF).Results: After radiofrequency ablation, there were 23 cases maintenance of sinus rhythm(non- recurrence group), and there were still 6 cases with atrial fibrillation (recurrence group). By echocardiography, in preoperative ablation: Compared with the control group,atrial fibrillation group:the left atrial diameter and volume increased(P﹤0.05), the A peak and LAEF decreased(P﹤0.05), the difference of pulmonary venous flow value had no statistically significance (P﹥0.05); the difference of the preoperative basic information between recurrence and non-recurrence group had no statistically significance (P﹥0.05). All the patients completed the 3-month follow-up,①24h after alation: Compared with preoperative, the recurrence and non-recurrence group’s LAVmin increased(P﹤0.05), mitral valve and pulmonary venous spectrum values and LAEF decreased (P﹤0.05), the LA diameter and LAVmax had no significant changes(P﹥0.05).②1 month after ablation: In the non-recurrence group, the LA diameter and volume reduced compared with preoperative (P﹤0.05), the A peak and LAEF increased compared with preoperative(P﹤0.05), the LAVmin reduced compared with postoperative 24h(P﹤0.01; In the recurrence group, the LA structure and function had no significant changes compared with preoperative (P﹥0.05), the LAVmin reduced compared with postoperative 24h(P﹤0.01); Within the two groups, the LA function improved compared with postoperative 24h(P﹤0.01); Compared with recurrence group, the LA diameter and volume of the non- recurrence group reduced(P﹤0.05), and the A peak and LAEF of the non- recurrence group increased(P﹤0.05).③3 months after ablation: In the non- recurrence group, the LA diameter and volume decreased compared with the preoperative (P﹤0.05), the A peak and LAEF increased compared with preoperative (P﹤0.05), the LA structure and function had no significant changes compared with postoperative 1 month(P﹥0.05); In recurrence group, the LA structure and function had no significant changes compared with preoperative and postoperative 1 month(P> 0.05); Compared with the recurrence group, the LA diameter and volume of the non- recurrence group reduced(P﹤0.05), and the A peak and LAEF of the non- recurrence group increased(P﹤0.05).Conclusion: Radiofrequency ablation is an effective method to treat atrial fibrillation, maintenance of sinus rhythm after ablation can reverse the LA structure and improve left atrial function, but the LA structure and function of the recurrence group had no significant changes.更多还原