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目的探讨不同的射频消融术式对阵发性心房颤动(PAf)患者左房功能的远期效应。方法PAf患者65例,接受节段性肺静脉隔离术(SPVI)27例和左房线性消融术(CPVA)38例,术后平均随访6~27(14.9±5.5)个月,应用超声心动图观察消融成功者手术前、后左房功能的变化,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,组织多普勒测量二尖瓣环舒张晚期运动速度(Va)。结果①SPVI组的27例患者中18例消融成功(66.7%),CPVA组的38例患者中28例消融成功(73.7%);②2组中消融成功者术前左房大小相似,术后长期维持窦性心律时左房内径减小(P<0.05);③消融成功者左房收缩功能好转,心房收缩期A波峰速度和积分都较术前升高(P<0.05),SPVI组的左房充盈分数比术前增加(P<0.05),CPVA组内左房射血力和左房充盈分数与术前比较差异无统计学意义;2组间比较血流频谱指标无差异,SPVI组Va高于CPVA组。结论射频消融术是治疗PAf的有效方法,长期随访显示消融成功者左房结构和收缩功能好转,但CPVA可能对左房局部收缩功能有影响。
Objective To investigate the long-term effects of different ablation procedures on left atrial function in patients with paroxysmal atrial fibrillation (PAf). Methods Sixty-five PAf patients underwent segmental pulmonary vein isolation (SPVI) in 27 cases and left atrium linear ablation (CPVA) in 38 cases. The mean follow-up time was 6-27 months (14.9 ± 5.5) months. The echocardiographic results The changes of left atrium function before and after ablation were evaluated with M-mode and two-dimensional ultrasonography, left ventricular diameter with Doppler, mitral flow spectrum with tissue Doppler, and late diastolic mitral annular velocity with tissue Doppler Va). Results ① The ablation was successful in 18 of 27 patients (66.7%) in the SPVI group and 28 of 38 patients in the CPVA group (73.7%). ② The size of the left atrium was similar in patients with successful ablation in group 2 and was maintained for a long time after surgery (P <0.05). ③After successful ablation, the left atrial systolic function improved, the atrial peak velocity and integral of systolic phase A increased (P <0.05), and the left atrium There was no significant difference in left ventricular ejection fraction and left atrium filling fraction in CPVA group between preoperative and postoperative periods (P <0.05) In the CPVA group. Conclusion Radiofrequency catheter ablation is an effective method for the treatment of PAf. Long-term follow-up shows that left atrial structure and systolic function improve after successful ablation, but CPVA may affect the local systolic function of left atrium.