2018 年第 10 期 第 13 卷

经导管射频消融对心房颤动患者术后早期心脏结构及功能的影响

Effect of radiofrequency catheter ablation on early postoperative cardiac structure and function in atrial fibrillation patients

作者：孔强史力生陈宇嘉喻荣辉龙德勇张钰聪徐东

英文作者：

单位：100053北京，首都医科大学宣武医院心脏内科（孔强、史力生、陈宇嘉、张钰聪、徐东）；100029首都医科大学附属北京安贞医院心内科（喻荣辉、龙德勇）

英文单位：

关键词：心房颤动；导管消融；心功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨经导管射频消融治疗对心房颤动患者术后早期心脏结构及功能的影响。方法    连续收集2009年1月1日至2014年12月31于首都医科大学宣武医院住院接受经导管射频消融治疗的心房颤动患者，选取资料完整的438例，其中阵发性心房颤动296例，持续性心房颤动142例，术前及术后第1天常规经胸进行了心脏彩色多普勒超声检查。比较不同心房颤动类型及不同心功能（左心室射血分数≥50%与＜50%）组间患者的临床指标差异，并探讨经导管射频消融对心房颤动患者术后早期心脏结构及功能的影响。结果    持续性心房颤动组患者心力衰竭比例高于阵发性心房颤动组［18.3%（26/142）比4.0%（12/296）］，差异有统计学意义（P<0.05）。术后次日持续性心房颤动组左心房直径、右心室舒张末期内径、室间隔运动幅度、左心室舒张末期内径、左心室舒张末期容积、二尖瓣E峰大于阵发性心房颤动组，左心室射血分数、肺动脉最大流速、三尖瓣E峰小于阵发性心房颤动组［（44±5）mm比（40±6）mm、（17.6±2.8）mm比（16.8±2.1）mm、（10.5±1.6）mm比（10.1±1.5）mm、（53±6）mm比（51±4）mm、（138±41）ml比(127±25)ml、（100±25）cm/s比（90±27）cm/s、（62±10）%比（65±8）%、（95±18）cm/s比（101±18）cm/s、（51±14）cm/s比（54±12）cm/s］，差异均有统计学意义（均P<0.05）。右心室流出道、左心室射血分数、心输出量、二尖瓣E峰、三尖瓣E峰在阵发性心房颤动组与持续性心房颤动组组内差异均有统计学意义（均P<0.05），而右心室流出道、左心室射血分数、每搏输出量在不同心功能分组组内差异均有统计学意义（均P<0.05）。结论    持续性心房颤动由于递进消融导致术后早期心功能减低，而术前左心室射血分数<50%的心房颤动患者，术后早期心脏收缩功能改善。

• 【Abstract】Objective    To investigate the effect of radiofrequency catheter ablation on early postoperative cardiac structure and function in patients with atrial fibrillation. Methods    Clinical data of 438 patients with atrial fibrillation(296 paroxysmal and 142 persistent atrial fibrillation) who underwent catheter ablation from 1st January 2009 to 31st December 2014 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Color Doppler echocardiography was performed before and on the first day after operation. Clinical characteristics were analyzed among patients with different types of atrial fibrillation and different heart function(left ventricular ejection fraction≥50% or ＜50%). Results    The ratio of heart failure in persistent atrial fibrillation group was higher than that in paroxysmal atrial fibrillation group［18.3%(26/142) vs 4.0%(12/296)］(P<0.05). On the first day after operation, left atrial diameter, right ventricular end-diastolic diameter, interventricular septal motion amplitude, left ventricular end-diastolic diameter, left ventricular end-diastolic volume and E peak of mitral valve in persistent atrial fibrillation group were larger than those in paroxysmal atrial fibrillation group; left ventricular ejection fraction, maximum pulmonary artery velocity and E peak of tricuspid valve were lower than those in paroxysmal atrial fibrillation group［（44±5）mm vs （40±6）mm, （17.6±2.8）mm vs （16.8±2.1）mm, （10.5±1.6）mm vs （10.1±1.5）mm, （53±6）mm vs （51±4）mm, （138±41）ml vs (127±25)ml, （100±25）cm/s vs （90±27）cm/s, （62±10）% vs （65±8）%, （95±18）cm/s vs （101±18）cm/s, （51±14）cm/s vs （54±12）cm/s］(P<0.05). Right ventricular outflow tract, left ventricular ejection fraction, cardiac output, mitral valve E peak and tricuspid valve E peak had significant differences between paroxysmal atrial fibrillation group and persistent atrial fibrillation group(P<0.05); right ventricular outflow tract, left ventricular ejection fraction and stroke output showed significant differences between the two groups of different heart function(P<0.05). Conclusions    Cardiac function decreases after catheter ablation for persistent atrial fibrillation. In patients with left ventricular ejection fraction＜50%, early postoperative cardiac function may increase after catheter ablation.