房室结消融及起搏器治疗改善心房颤动患者心功能和生活质量的研究

探讨房室结消融 +VVIR起搏器 (ABL +PM)治疗对永久性心房颤动 (简称房颤 )患者生活质量、心功能的改善及评估该治疗的安全性。选择 30例永久性房颤患者 ,14行例ABL +PM治疗 ,16例行药物治疗。治疗前及治疗后 12个月所有患者均做GWB和CSS生活质量评分 ,心脏超声测左室内径及射血分数值 ,活动平板测运动耐力 ,用Holter记录最快、最慢心率。并观察治疗后临床事件的发生。结果 :永久性房颤患者ABL +PM或药物治疗前、后组内比较 ,患者心室率、心功能、运动耐力及生活质量均得到改善 (P <0 .0 5 ) ;但ABL +PM组左室内径缩小 (P <0 .0 5 ) ,药物治疗组无改变 (P >0 .0 5 )。ABL +PM或药物治疗后 12个月组间比较 ,ABL +PM组心室率控制、左室内径、心功能、运动耐力及生活质量改善优于药物组 (P <0 .0 5 )。再次住院人次ABL +PM组较药物组减少 (P <0 .0 5 ) ,死亡、恶性室性心律失常和血栓栓塞事件两组无差异 (P >0 .0 5 )。结论 :ABL +PM或药物治疗均能改善永久性房颤患者心功能、运动耐力及生活质量 ,但ABL +PM优于药物治疗。ABL +PM是一种简单易行安全的治疗方法。

Assessment of the Beneficial Effect of Atrioventricular Node Ablation and Pacemaker on Quality of Life and Cardiac Function of Patients With Permanent Atrial Fibrillation

To evaluate the beneficial effect of Atrioventricular node ablation and VVIR pacemaker(ABL+PM) on quality of life and cardiac function of patients with permanent atrial fibrillation(AF) and the safety of this therapy,30 patients with permanent AF were enrolled. 14 patients in ABL+PM group, the others in drug group. All patients were observed quality of life (GWB′scores and CSS′scores), measured left ventricular end-diastolic diameter and ejection fraction by echocardiaography and exercise duration on treadmill testing, evaluated the minimum and maximum heart rate by Holter before and after 12 months treatment. Results:The intrapatient comparison between enrollment and month 12 showed that quality of life,heart function,exercise intolerance and heart rate improved in both groups (P<0.05), but left ventricular end-diastolic diamet diameter decreased in ABL+PM group (P<0.05), didn't in drug group (P>05). There was significant difference in quality of life,left ventricular end-diastolic diamet diameter,heart function,exercise intolerance and heart rate when ABL+PM group compared with drug group after treatment (P<0.05). Death,life-threatening ventricular arrhythmias and the events of thromboembolism were no difference between the ABL+PM group and drug group(P>0.05), while episodes of hospitalization reduced in the ABL+PM group(P<0.05). Conclusions: Quality of life and heart function of patients with permanent AF are improved by the ABL+PM or pharmacological treatment, but the ABL+PM treatment is superior to drug therapy. The ABL+PM treatment is a easily performed and safe method.