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目的:评价环肺静脉左房线性消融术对阵发性心房颤动(房颤)患者左心房结构和功能的影响。方法:阵发性房颤患者33例,Carto系统下行环肺静脉左房线性消融术,应用超声心动图测定其消融术前1～3 d、术后1、3、6、12个月静息时窦性心律下左心房内径、容积指标、二尖瓣口A波速度峰值(VA)及E波速度峰值(VE),并计算左心房排空分数,分析消融术前后左心房结构和功能的变化。结果:33例阵发性房颤患者均成功施行环肺静脉左房线性消融术,1年治愈率82%。左房前后径消融术后1个月较术前显著增大[(44±4)mm vs.(41±3)mm,P<0.01],术后3个月、6个月时与术前比较无显著差异,随访1年时左房前后径较术前有显著减小[(40±3)mm vs.(41±3)mm,P<0.05]。与左心房辅助泵功能相关的左心房最小容积,术后1个月显著增大,左心房主动排空分数、左心房总排空分数显著降低(P<0.05),术后3个月时恢复到术前水平。VA术后均低于术前(P<0.05,P<0.01),而VE/VA术后1个月显著上升(P<0.05,P<0.01),但在随后的随访中与术前无显著差异。结论:阵发性房颤患者左房环肺静脉线性消融术后近期左房前后径增大,辅助泵功能下降,术后3个月恢复至术前水平,术后1年左房结构可部分逆重构。
Objective: To evaluate the effects of circumferential pulmonary vein ablation on left atrial structure and function in patients with paroxysmal atrial fibrillation (AF). Methods: Thirty-three patients with paroxysmal atrial fibrillation underwent Cartan system descending pulmonary AVR (left atrium linear ablation). Their echocardiograms were performed 1 to 3 days before ablation, resting at 1, 3, 6 and 12 months after operation Left atrial diameter, volumetric index, peak A wave velocities (VA) and peak E wave velocities (VE) of sinus rhythm were calculated and the left atrial emptying fraction was calculated. The structure and function of the left atrium before and after ablation Variety. Results: Thirty-three patients with paroxysmal atrial fibrillation were successfully treated with left atrium pulmonary vein ablation. The one-year cure rate was 82%. The left atrium anterior and posterior diameter ablation was significantly increased 1 month after surgery compared with preoperative [(44 ± 4) mm vs. (41 ± 3) mm, P <0.01], 3 months and 6 months postoperatively There was no significant difference between the two groups (P> 0.05). The anteroposterior diameter of left anterior descending after one year follow-up was significantly lower than that before the operation ([40 ± 3] mm vs. (41 ± 3) mm, P <0.05). The left atrium minimum volume associated with left atrial-assisted pump function was significantly increased at 1 month after surgery, with active left ventricular ejection fraction and total left ventricular fractional emptying significantly reduced (P <0.05), resumed at 3 months To the preoperative level. VA was significantly lower than that before operation (P <0.05, P <0.01), but VE / VA one month after operation increased significantly (P <0.05, P <0.01), but no significant difference between the follow-up and preoperative difference. Conclusions: The anteroposterior diameter of left anterior chamber increases shortly after linear ablation of left atrium pulmonary vein in patients with paroxysmal atrial fibrillation, the function of auxiliary pump decreases, and the level of auxiliary pump returns to preoperative level at 3 months after operation. Reconstruction.