射频消融术对非瓣膜性阵发性心房纤颤患者左心耳血流速度及心脏结构和功能的影响
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摘要
目的探讨射频消融术对非瓣膜性阵发性房颤患者恢复窦性心律后左心耳血流速度及心脏结构和功能的影响。方法对2013年1月至2017年12月南昌大学第三附属医院收治的非瓣膜性阵发性房颤患者50例行射频消融术治疗,术前及术后恢复并维持窦性心律6个月后分别进行经胸心脏超声和经食道超声,比较2个时间点左心耳血流速度(LAAFV)、左心房直径(LAD)、左心室射血分数(LVEF)、舒张早期二尖瓣血流(E)、心房收缩期二尖瓣血流(A)和舒张早期室间隔二尖瓣环速度(e′)、舒张早期和心房收缩期二尖瓣血流速度比率(E/A)及早期舒张期二尖瓣血流与室间隔二尖瓣环速度比值(E/e′)。结果与术前相比,50例患者在术后恢复并维持窦性心律6个月后,LAAFV明显提升、LAD明显变小、LVEF明显提高、A明显提高、E/A明显变小,差异均有统计学意义(P<0.05);E、e′、E/e′无明显变化,差异均无统计学意义(P>0.05)。结论射频消融术后成功转为窦性心律并维持窦性心律后患者LAAFV明显加快,LAD变小,表明左心房的结构和生理逆向重塑得到了明显改善。
Objective To investigate the effects of radiofrequency ablation on left atrial appendage flow velocity(LAAFV) and cardiac structure and function in patients with nonvalvular paroxysmal atrial fibrillation.Methods Fifty patients with nonvalvular paroxysmal atrial fibrillation underwent radiofrequency ablation in the Third Affiliated Hospital of Nanchang University between January 2013 and December 2017.Transthoracic and transesophageal echocardiography were performed to measure LAAFV,left atrium diameter(LAD),left ventricular ejection fraction(LVEF),early diastolic mitral flow(E),atrial systolic mitral flow(A),early diastolic mitral annulus velocity(e′),E/A ratio and E/e′ ratio before operation and after postoperative sinus rhythm maintenance for 6 months.Results Compared with the values measured before radiofrequency ablation,LAAFV,LVEF and A increased but LAD and E/A decreased after postoperative sinus rhythm maintenance for 6 months(P<0.05).No obvious changes were found in E,e′ and E/e′(P>0.05).Conclusion LAAFV increases and LAD decreases in patients with maintained sinus rhythm after radiofrequency ablation,suggesting that radiofrequency ablation can improve left atrial structure and physiological reverse remodeling in patients with nonvalvular paroxysmal atrial fibrillation.
Objective To investigate the effects of radiofrequency ablation on left atrial appendage flow velocity(LAAFV) and cardiac structure and function in patients with nonvalvular paroxysmal atrial fibrillation.Methods Fifty patients with nonvalvular paroxysmal atrial fibrillation underwent radiofrequency ablation in the Third Affiliated Hospital of Nanchang University between January 2013 and December 2017.Transthoracic and transesophageal echocardiography were performed to measure LAAFV,left atrium diameter(LAD),left ventricular ejection fraction(LVEF),early diastolic mitral flow(E),atrial systolic mitral flow(A),early diastolic mitral annulus velocity(e′),E/A ratio and E/e′ ratio before operation and after postoperative sinus rhythm maintenance for 6 months.Results Compared with the values measured before radiofrequency ablation,LAAFV,LVEF and A increased but LAD and E/A decreased after postoperative sinus rhythm maintenance for 6 months(P<0.05).No obvious changes were found in E,e′ and E/e′(P>0.05).Conclusion LAAFV increases and LAD decreases in patients with maintained sinus rhythm after radiofrequency ablation,suggesting that radiofrequency ablation can improve left atrial structure and physiological reverse remodeling in patients with nonvalvular paroxysmal atrial fibrillation.
引文
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[11] AGMON Y,KHANDHERIA B K,MEISSNER I,et al.Left atrial appendage flow velocities in subjects with normal left ventricular function[J].Am J Cardiol ,2000,86(7):769-773.
[12] LEE S H,CHOI S,CHUNG W J,et al.Tissue Doppler index,E/E′,and ischemic stroke in patients with atrial fibrillation and preserved leftventricular ejection fraction[J].J Neurol Sci 2008,271(1/2):148-152.
[2] CALKINS H,KUCK K H,CAPPATO R,et al.HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:a report of the heart rhythm society(HRS) task force on catheter and surgical ablation of atrial fibrillation[J].Heart Rhythm,2012,9(4):632-696.
[3] CHAO T F,LIN Y J,TSAO H M,et al.CHADS2 and CHA2DS2-VASc scores in the prediction of clinical outcomes in patients with atrial fibrillation after catheter ablation[J].J Am Coll Cardiol,2011,58(23):2380-2385.
[4] HANDKE M,HARLOFF A,HETZEL A,et al.Left atrial appendage flow velocity as a quantitative surrogate parameter for thromboembolic risk:determinants and relationship to spontaneous echocontrast and thrombus formation—a transesophageal echocardiographic study in 500 patients with cerebral ischemia[J].J Am Soc Echocardiogr,2005,18(12):1366-1372.
[5] LEUNG D Y,BOYD A,NG A A,et al.Echocardiographic evaluation of left atrial size and function:current understanding pathophysiologic corelates and prognostic implications[J].Am Heart J,2008,156:1056-1064.
[6] CASACLANG VERZOSA G,GERSH B J,TSANG T S.Structural and functional remodeling of the left atrium:clinical and therapeutic implications for atrial fibrillation[J].J Am Coll Cardiol,2008,51(1):501-511.
[7] CHAO T H,TSAI L M ,TSAI W C,et a1.Ellect of atrial fibrillation on pulmonary venous flow patterns assessed by Doppler transesophageal echocardiography[J].Chest,2000,117(6):1546-1550.
[8] TSANG T S,BARNES M E,GERSH B J,et al.Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden[J].J Am Coll Cardiol,2002,90(12):1284-1289.
[9] KIM D H,KIM G C,KIM S H,et al.The relationship between the left artrial volume and the maximum P-wave and P-wave dispersion in patients with congestive heart failure [J].Yonsei Med J,2007,48(5):810-817.
[10] OMRAN H,JUNG W,RABAHIEH R,et al.Left atrial chamber and appendage function after internal atrial defibrillation:a prospective and serial transesophageal echocardiographic study[J].J Am Coll Cardiol,1997,29(1):131-138.
[11] AGMON Y,KHANDHERIA B K,MEISSNER I,et al.Left atrial appendage flow velocities in subjects with normal left ventricular function[J].Am J Cardiol ,2000,86(7):769-773.
[12] LEE S H,CHOI S,CHUNG W J,et al.Tissue Doppler index,E/E′,and ischemic stroke in patients with atrial fibrillation and preserved leftventricular ejection fraction[J].J Neurol Sci 2008,271(1/2):148-152.