射频消融术治疗心房颤动性心肌病的临床观察
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摘要
目的观察射频消融术(RFCA)治疗心房颤动(房颤)性心肌病的临床疗效及安全性。方法选取心功能减低(EF<50%)、左心房和(或)左心室扩大的房颤性心肌病患者25例,经RFCA治疗后随访6个月。比较术前及术后6个月心率和窦性心律维持情况、左心室射血分数(LVEF)、左心房前后径(LAD)、左心室舒张末期内径(LVEDD)及6 min步行距离(6-MWT)。结果 25例患者经RFCA治疗后有3例持续性房颤和1例阵发性房颤患者术后复发,RFCA成功率为84.0%(21/25)。所有患者术中、术后无心包填塞、冠状动脉损伤等严重并发症。RFCA术后6个月LVEF、6-MWT提高,LAD及LVEDD缩小,与术前比较差异均有统计学意义(P<0.01)。结论 RFCA治疗房颤性心肌病安全有效。
Objective To observe the clinical efficacy and safety of radiofrequency catheter ablation(RFCA) in the treatment of arterial fibrillation-induced cardiomyopathy.Methods 25 atrial fibrillation-induced cardiomyopathy patients with cardiac dysfunction(EF<50%),left atrial and/or ventricular enlargement were enrolled,and they were treated by RFCA and followed up for 6 months.Heart rate and sinus rhythm maintenance,left ventricular ejection fraction(LVEF),left atrial dimension(LAD),left ventricular end-diastolic diameter(LVEDD),and 6-minute walking test(6-MWT)were compared before and after operation of 6 months.Results In 25 patients,3 patients with persistent atrial fibrillation and 1 patient with paroxysmal atrial fibrillation had recurrence postoperatively,which led to an effective rate of 84.0%(21/25).There was no pericardial tamponade,coronary artery injury or other serious complications.6 months after RFCA,LVEF and 6-MWT increased,while LAD and LVEDD decreased,the differences were statistically significant(P<0.01).Conclusion RFCA is safe and effective in the treatment of atrial fibrillation-induced cardiomyopathy.
Objective To observe the clinical efficacy and safety of radiofrequency catheter ablation(RFCA) in the treatment of arterial fibrillation-induced cardiomyopathy.Methods 25 atrial fibrillation-induced cardiomyopathy patients with cardiac dysfunction(EF<50%),left atrial and/or ventricular enlargement were enrolled,and they were treated by RFCA and followed up for 6 months.Heart rate and sinus rhythm maintenance,left ventricular ejection fraction(LVEF),left atrial dimension(LAD),left ventricular end-diastolic diameter(LVEDD),and 6-minute walking test(6-MWT)were compared before and after operation of 6 months.Results In 25 patients,3 patients with persistent atrial fibrillation and 1 patient with paroxysmal atrial fibrillation had recurrence postoperatively,which led to an effective rate of 84.0%(21/25).There was no pericardial tamponade,coronary artery injury or other serious complications.6 months after RFCA,LVEF and 6-MWT increased,while LAD and LVEDD decreased,the differences were statistically significant(P<0.01).Conclusion RFCA is safe and effective in the treatment of atrial fibrillation-induced cardiomyopathy.
引文
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[9] 黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议—2018[J].中国心脏起搏与心电生理杂志,2018,32(4):315-368.DOI:10.13333/j.cnki.cjcpe.2018.04.001.
[2] Lau DH,Thiyagarajah A,Willems S,et al.Device therapy for rate control:pacing,resynchronization and AV node ablation[J].Heart Lung Circ,2017,26(9):934-940.DOI:10.1016/j.hlc.2017.05.124.
[3] 郭继鸿.心房颤动性心肌病[J].临床心血管病杂志,2016,32(4):319-324.DOI:10.13201/j.issn.1001-1439.2016.04.001.
[4] January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society[J].Circulation,2014,130(23):e199-267.DOI:10.1161/CIR.0000000000000040.
[5] Im SI,Chun KJ,Park SJ,et al.Long-term prognosis of paroxysmal atrial fibrillation and predictors for progression to persistent or chronic atrial fibrillation in the korean population[J].J Korean Med Sci,2015,30(7):895-902.DOI:10.3346/jkms.2015.30.7.895.
[6] Iwasaki YK,NishidaK,Kato T,et al.Atrial fibrillation pathophysiology:implications for management[J].Circulation,2011,124(20):2264-2274.DOI:10.1161/CIRCULATIONAHA.111.019893.
[7] Marrouche NF,Brachmann J,Andresen D,et al.Catheter ablation for atrial fibrillation with heart failure[J].N Engl J Med,2018,378(5):417-427.DOI:10.1056/NEJMoa1707855.
[8] Di Biase L,Mohanty P,Mohanty S,et al.Response by Di Biase et al to Letter Regarding Article,“Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device:results from the AATAC multicenter randomized trail”[J].Circulation,2016,134(10):e189-190.DOI:10.1161/CIRCULATIONAHA.116.024003.
[9] 黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议—2018[J].中国心脏起搏与心电生理杂志,2018,32(4):315-368.DOI:10.13333/j.cnki.cjcpe.2018.04.001.