射频导管消融后窦性心律维持对持续性心房颤动患者左心收缩和舒张功能的影响

目的探讨持续性心房颤动(房颤)患者射频消融后窦性心律维持对左心收缩和舒张功能的影响。方法入选2015年12月至2016年12月在江苏省人民医院心内科接受射频消融的持续性房颤患者。前瞻性观察术后第3天、1、2、3、6及12个月患者左心收缩功能[左心房内径(LAD)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]和左心舒张功能[舒张早期经二尖瓣血液流速峰值与舒张晚期流速峰值的比值(E/A)、舒张早期经二尖瓣血液流速峰值与二尖瓣环运动速度比值(E/e′)]的变化。术后相应随访时间点行24 h动态心电图检查以判断房颤是否复发。结果本研究共纳入持续性房颤患者34例,其中男27例、女7例,年龄(59.7±9.1)岁。术后第1、2、3、6和12个月LAD分别为(42.5±4.2)mm、(41.4±4.2)mm、(40.7±3.8)mm、(40.0±3.6)mm及(40.2±3.8)mm,较术后第3天(46.7±4.1)mm明显降低,差异有统计学意义(P<0.001)。术后第12个月LVESD较术前明显降低[(29.8±2.5)mm对(32.4±4.8)mm,P=0.02],但术后第1、2、3、6和12个月的LVEDD与术前相比差异无统计学意义(P=0.93、P=0.83、P=0.90、P=0.54、P=0.76)。术后第2、3、6和12个月时LVEF(66.3%±5.0%,66.7%±5.9%,66.6%±5.9%、68.7%±4.5%)与术前(62.2%±7.0%)相比明显提高,差异有统计学意义(P=0.05、P=0.01、P=0.02、P=0.001);术后第2、3、6和12个月LVEF与术后第1个月相比差异无统计学意义(P=0.73、P=0.54、P=0.57、P=0.10)。术后第1、2、3、6及12个月E/A(1.2±0.6、1.3±1.0、1.1±0.6、1.1±0.3、1.1±0.4)与术后第3天(2.4±1.0)相比差异有统计学意义(P<0.001)。同样,术后第1、2、3、6及12个月的E/e′(11.7±3.5、11.1±3.9、10.9±3.0、11.6±3.2、12.0±3.3)与术后第3天(14.7±4.6)相比差异具有统计学意义(P=0.002、P=0.001、P=0.001、P=0.002、P=0.01)。2例患者分别于术后第6个月和术后1年复发,再次消融均成功。1例患者术后12个月时失访。结论射频导管消融可改善持续性房颤患者的左心收缩和舒张功能,术后第1个月患者的收缩和舒张功能基本恢复。

Effect of sinus rhythm maintaining after radiofrequency ablation on left atrial and ventricular systolic and diasystolic function in patients with persistent atrial fibrillation

Objective To investigate the impact of sinus rhythm maintaining after radiofrequency ablation on left atrial and ventricular systolic and diastolic function in patients with persistent atrial fibrillation(PAF).Methods This prospective observational study including patients who suffered from PAF and received radiofrequency ablation treatment in the First Affiliated Hospital of Nanjing Medical University between December 2015 and December 2016.Transthoracic echocardiography was used to evaluate cardiac systolic function[left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)],diastolic function[the ratio of early transmitral flow velocity(E)to the ratio of later transmitral flow velocity(A)(E/A),E to early mitral annular velocity(e′)(E/e′)]at the time 3rd day,1st,2nd,3rd,6th and 12th month after ablation procedure,respectively.Meanwhile,Holter recording was performed at very follow-up time point.Results This study included 34 PAF patients[27 men,mean age(59.7±9.1)years old]who suffered from PAF.There was significant difference of LAD between the 1st,2nd,3rd,6th and 12th month[(42.5±4.2)mm,(41.4±4.2)mm,(40.7±3.8)mm,(40.0±3.6)mm and(40.2±3.8)mm]and the 3rd day after ablation procedure[(46.7±4.1)mm,P<0.001],respectively.There was significant difference of LVESD between the 12th month after ablation procedure and baseline[(29.8±2.5)mm vs.(32.4±4.8)mm,P=0.02].However,there was no significant difference of LVEDD between the 1st,2nd,3rd,6th and 12th month after ablation procedure and baseline(P=0.93,0.83,0.90,0.54 and 0.76),respectively.There was significant difference of LVEF between the 2nd,3rd,6th and 12th month after ablation procedure(66.3%±5.0%,66.7%±5.9%,66.6%±5.9%and 68.7%±4.5%)and baseline(62.2%±7.0%,P=0.05,0.01,0.02 and 0.001),respectively.However,there was no significant difference of LVEF between the 2nd,3rd,6th and 12th month after ablation procedure and the 1st month after procedure(P=0.73,0.54,0.57and 0.10),respectively.There was significant difference of E/A between the 1st,2nd,3rd,6th and 12th month(1.2±0.6,1.3±1.0,1.1±0.6,1.1±0.3 and 1.1±0.4)and the 3rd day after procedure(2.4±1.0,P<0.001),respectively.Similarly,there was also significant difference of E/e′between the 1st,2nd,3rd,6th and 12th month(11.7±3.5,11.1±3.9,10.9±3.0,11.6±3.2 and 12.0±3.3)and the 3rd day after ablation procedure(14.7±4.6,P=0.002,0.001,0.001,0.002 and 0.01),respectively.PAF reoccurred in two patients at the 6th and 12th month,respectively.Repeated ablation was successful for these two patients.Follow-up was lost in one patient at the 12th month after ablation procedure.Conclusion Left atrial and ventricular systolic and diastolic function could reverse by radiofrequency ablation in patients with PAF.Besides,systolic and diastolic function of left heart improved significantly at the 1st month after ablation procedure.