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目的观察分析特发性持续性房颤行房颤射频消融术后血浆脑钠肽(BNP)浓度及左房功能的变化。方法选取临床20例特发性持续性房颤患者,这些患者均行CARTO三维标测系统指导下的以环双肺静脉电隔离术为基础的导管消融术。分别于术前、术后1周、1个月、3个月随访观察血浆BNP浓度和心脏彩超。结果射频消融术后血浆BNP浓度、左房内径于术后1周、1个月、3个月减少,与术前相比差异有统计学意义(P<0.05),这种变化持续至术后3个月;左房排空分数和左室射血分数于术后1周、1个月、3个月持续增加,差异有统计学意义(P<0.05)。术后窦性心律维持组BNP平均浓度和左房平均内径小于房颤复发组,左房排空分数和左室射血分数大于房颤复发组,差异均有统计学意义(P<0.05);直线回归分析表明,在术后随访过程中,BNP浓度变化与左房内径变化呈正相关(P<0.05),与左房排空分数和左室射血分数变化呈负相关(P<0.05)。结论以环双肺静脉电隔离术为基础的房颤射频消融术使特发性持续性房颤患者复律后,可使血浆BNP浓度减少,左房内径减少,左房排空分数和左室射血分数增加,左房功能改善。
Objective To observe the changes of plasma brain natriuretic peptide (BNP) concentration and left atrial function after atrial fibrillation ablation in patients with idiopathic persistent atrial fibrillation. Methods Twenty patients with idiopathic persistent atrial fibrillation (AF) were enrolled in this study. These patients underwent catheter ablation under the guidance of CARTO 3D mapping system. Plasma BNP concentration and echocardiography were observed at preoperative, postoperative 1 week, 1 month and 3 months respectively. Results After RFA, plasma BNP concentration and left atrial diameter decreased at 1 week, 1 month and 3 months after operation, showing significant difference compared with those before operation (P <0.05). This change continued until after operation The left ventricular fractional emptying and left ventricular ejection fraction increased at 1 week, 1 month and 3 months after operation. The difference was statistically significant (P <0.05). The average concentration of BNP and left atrium mean internal diameter in sinus rhythm maintenance group were less than those in atrial fibrillation recurrence group, left atrium emptying fraction and left ventricular ejection fraction were higher than those in atrial fibrillation recurrence group (P <0.05). Linear regression analysis showed that the change of BNP concentration was positively correlated with the change of left atrium diameter (P <0.05) during postoperative follow-up, and negatively correlated with left ventricular fractional emptying and left ventricular ejection fraction (P <0.05). CONCLUSIONS: Atrial fibrillation radiofrequency catheter ablation based on circumflex double pulmonary vein isolation can decrease plasma BNP concentration, reduce left atrial diameter, left atrium emptying fraction and left ventricular ejection fraction after cardioversion in patients with idiopathic persistent AF. Blood increased, left atrial function improved.