环肺静脉隔离术对阵发性心房颤动患者左心房大小和功能的影响

目的:探讨环肺静脉隔离术对阵发性心房颤动(Af)患者左心房大小和功能的影响。方法:28例阵发性Af患者择期行环肺静脉隔离术,根据Af复发与否分为复发组(5例)和未复发组(23例);同期选择窦性心律患者30例作为对照组。应用超声心动图对所有患者在窦性心律下于术前、术后24h、1个月和3个月时测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、二尖瓣环晚期运动峰值速度(A峰)、肺静脉收缩期波(S峰)、舒张期波(D峰)、心房血流逆向波(PVa峰),并计算左心房射血分数(LAEF)。结果:①左心房大小:复发组和未复发组患者消融术前LAVmax和LAVmin均较对照组增加(均P<0.05),在术后24hLAVmin均增加(均P<0.01),LAVmax无明显变化;未复发组术后1个月时LAVmax、LAVmin均减小至正常(均P<0.05),术后3个月时未再进一步减小,而复发组术后1个月和3个月恢复至术前大小。②左心房功能:复发组和未复发组消融术前LAEF和A峰值均较对照组降低(均P<0.05),术后24h左心房功能指标均较术前明显降低(均P<0.05);术后1个月时复发组和未复发组左心房功能指标较术后24h均明显增加(均P<0.01),2组PVa峰、S峰和D峰值均恢复至术前正常水平(均P<0.05),LAEF和A峰在未复发组增加至正常水平(P<0.05),而在复发组仅恢复至术前水平;术后3个月时左心房功能指标较术后1个月时均未再有明显变化。结论:环肺静脉隔离术可以逆转阵发性Af造成的左心房大小和功能异常,而且长期对左心房大小和功能无负面影响。

Effect of circumferential pulmonary vein isolation on left atrial size andfunction in patients with paroxysmal atrial fibrillation

Objective:To evaluate the effect of circumferential pulmonary vein isolation(CPVI) on left atrial(LA) size and function in patients with paroxysmal atrial fibrillation(Af). Method:Twenty-eight patients with paroxysmal Af who undertaken CPVI guided by EnSite 3000,were divided into 2 groups:recurrence group(n=5) and non-recurrence group(n=23).Thirty volunteers with sinus rhythm of matched age were enrolled as control group.Echocardiography was performed before CPVI and 24 h,1 month and 3 months after CPVI. Result:LA maximum volume(LAVmax) and LA minimum volume(LAVmin) in patients with paroxysmal Af were significantly increased,compared with control volunteers(both P<0.05),whereas mitral peak A wave velocity(VA) and LA ejection fraction(LAEF) were decreased significantly(both P<0.05).LAVmax and LAVmin were increased 24 h after CVPI(both P<0.05),whereas VA and LAEF were significantly decreased,compared with that before CPVI(both P<0.01).One month after CPVI,these changes,which were returned to pre-CVPI levels in recurrence group were reversed to normal levels in non-recurrence group(P<0.05).Three months after CPVI,there were no significant differences of these indicators compared with that 1 month after CPVI in both non-recurrence groups and recurrence group. Conclusion:CPVI reverses the left atrial volume and function abnormalities caused by paroxysmal Af in early phase after operation,and do not induce atrial remodling in late phase.