环肺静脉射频消融对心房颤动患者抑郁和生活质量的影响

目的探讨环肺静脉射频消融对心房颤动(简称房颤)患者抑郁和生活质量的影响。方法入选98例行房颤环肺静脉消融治疗的患者(手术组)和102例同期入院未行手术治疗的房颤患者(药物组)。所有患者于纳入研究时和治疗后12个月填写抑郁自评量表(SDS)、生活质量量表(SF-36),采集血常规、肝肾功能、胸部平片、心脏超声、12导同步心电图和24 h动态心电图资料。纳入研究后12个月门诊复查12导同步心电图和24 h动态心电图。对手术组、药物组、手术组术后12个月复发组和未复发组的上述各项指标进行组间和组内比较。对有统计学差异的指标进行多元线性回归分析。结果手术组术后12个月SF-36评分高于术前,SDS粗分和标准分低于术前(P均<0.01)。药物组纳入时和纳入后12个月SDS和SF-36评分无差异。与药物组比较,手术组纳入时的SDS、SF-36无差异,纳入后12个月SDS降低、SF-36增加(P均<0.05)。手术组中复发组和未复发组SDS和SF-36评分有差异(P<0.05)。左房内径[OR=3.28,95%CI(3.07,3.52),P<0.05]和抑郁[OR=2.40,95%CI(2.24,2.85),P<0.05]是房颤环肺静脉射频消融术后复发的独立危险因素。结论环肺静脉射频消融能显著改善房颤患者抑郁状态。左房增大和抑郁状态是房颤射频消融术后复发的独立危险因素。     

心房纤维化与非阵发性心房颤动的导管消融

以心房纤维化为主要特征的结构重构在非阵发性心房颤动(简称房颤)的发生、进展及维持中起重要作用。非阵发性房颤的消融策略主要为在环肺静脉电隔离基础上附加线性消融、碎裂电位消融、自主神经节丛消融、转子消融等,各消融策略的确切效果仍有待进一步研究;窦性心律下,左房纤维化心肌经高密度电压标测后主要表现为低电压区和瘢痕区。环肺静脉电隔离联合电压标测指导的个体化消融策略有望进一步提高非阵发性房颤的消融成功率。     

老年心房颤动患者的导管消融治疗进展

老年心房颤动(简称房颤)的导管消融治疗的有效性和安全性存在争议。最近研究表明在经验丰富的医学中心,老年房颤患者导管消融治疗的有效性和安全性与年轻患者相似,导管消融治疗逐渐成为老年房颤治疗的重要方法。     

焦虑、抑郁情绪对心房颤动患者生活质量的影响

目的 探讨心房颤动（简称房颤）患者焦虑、抑郁情绪的发生情况及其与患者生活质量（QOL）的关系.方法 入选房颤患者80例,根据主诉、病史、体格检查及其他辅助检查排除器质性心脏病及可引发心房颤动的其他器质性疾病,选取同年龄、同性别的80名健康人（无器质性疾病及精神疾病）作为对照组,采用美国简明健康测量量表（SF-36）评估两组受试者生活质量评分,采用医院焦虑、抑郁量表（HADS）评估两组受试者的情绪情况,通过SPSS 12.0软件对患者生活质量评分和焦虑抑郁评分进行统计分析.结果 根据HADS评分结果,房颤患者情绪反应阳性（焦虑或抑郁）53例,占66.3％,情绪反应阴性27例,占33.7％;对照组情绪反应阳性5例,占6.25％,两组比较差异有统计学意义（x2 =62.31,P＜0.01）.将80例房颤患者分为情绪异常组和情绪正常组,两组患者生活质量评分比较差异有统计学意义（P＜0.05）.分别以焦虑、抑郁情绪评分和患者生活质量各维度评分进行相关分析,发现房颤患者生活质量各维度评分与焦虑、抑郁情绪反应程度呈负相关（P＜0.05）.结论 房颤患者常伴有焦虑或抑郁情绪反应;且焦虑、抑郁情绪反应程度越严重,患者生活质量下降越明显.     

超重和肥胖对心房颤动导管消融复发的影响

目的探讨超重和肥胖对心房颤动(简称房颤)导管消融复发的影响。方法回顾性分析连续入院在三维标测系统指导下行环肺静脉线性消融的患者369例,复发定义为消融1个月后发生持续30s以上的房性快速性心律失常,以体重指数≥25.0kg/m2做为超重和肥胖的诊断标准。结果369例中超重和肥胖199例,左房前后径和左室舒张末径在超重和肥胖组显著大于非超重和肥胖组(40.2±6.0mmvs36.6±6.5mm,P<0.001;49.1±7.1mmvs46.9±6.6mm,P=0.003)。随访459±181天,超重和肥胖组复发率为40.2%,非超重和肥胖组的复发率为25.9%,两组间差异有显著性(P=0.004)。单因素分析发现超重和肥胖、持续性/永久性房颤、左房前后径、左室舒张末径是导管消融复发的预测因素。经校正房颤病程、房颤类型、高血压、器质性心脏病,Cox多因素分析显示超重和肥胖是房颤复发的独立危险因素(危险比=1.67,95%可信区间1.13～2.46,P=0.009)。进一步校正左房前后径和左室舒张末径,Cox多因素分析发现只有左房前后径是复发的独立预测因素(危险比=1.04,95%可信区间1.01～1.08,P=0.010)。结论超重和肥胖是影响房颤导管消融复发的重要因素,其机制可能是通过左房增大介导的。     

射频消融对室性早搏患者生活质量的影响

目的观察室性早搏(简称室早)患者射频消融术前后生活质量的变化,探讨射频消融对室早患者生活质量的影响。方法入选58例,男27例、女31例,年龄30±34(17~67)岁,其中51例右室流出道室早,5例左室流出道室早,2例左室流入道室早,在术前和术后分别填写SF-36调查表,由患者本人在半小时内完成,观察一般健康状况(GH)、生理功能、生理职能(RP)、躯体疼痛、精力、社会功能、情感职能(RE)、精神健康指标,量表采用标准分法进行评分、统计分析。结果所有患者均成功地进行了射频消融,术后1周至1个月内,患者整体的生活质量有明显提高;不同年龄段生活质量改变无显著差异;但对女性的改变程度的GH、RP、RE3个指标较男性更显著,P<0.05。结论射频消融治疗室早能显著改善患者生活质量。     

老年人阵发性心房颤动的导管消融治疗

为评价老年人阵发性心房颤动 (PAF)行导管消融治疗的可行性和疗效 ,选择药物无法控制或不能耐受的PAF患者 5 6例 ,男 4 1例、女 15例 ,年龄 6 5 .7± 10 .1(6 0～ 74 )岁 ,无器质性心脏病 4 6例 ,合并高血压 7例 ,高血压及糖尿病 1例 ,高血压及冠心病 1例 ,冠心病 1例。均经食管超声心动图检查排除左房血栓。据消融技术的演进及患者入选的时间顺序 ,采用不同的消融方法 (点消融术、超声球囊肺静脉电隔离术、肺静脉节段性消融电隔离术 )。 3～ 6个月后评价疗效。结果 :5 6例患者 ,5 5例完成消融术 :点消融术 4例 ,成功 1例 ,无效 2例 ,心包积血 1例 ;超声球囊肺静脉电隔离术 14例 ,成功 7例 ,有效 5例 ,无效 2例 ,无肺静脉狭窄 ;肺静脉节段性消融电隔离术 37例 ,成功11例 ,有效 2 3例 ,无效 3例 ,左下肺静脉开口 >30 %狭窄 1例。结论 :导管消融治疗老年人PAF是安全有效的 ,肺静脉电隔离术使疗效明显提高 ,但仍未令人满意。     

药物治疗与导管消融对心房颤动患者左心房结构、功能及生活质量影响

目的 对比药物治疗与导管消融对心房颤动（房颤）患者左心房结构、功能及生活质量的影响.方法 2012年1月至2013年6月在第三军医大学西南医院心血管内科住院的200例未行导管消融的房颤患者,年龄17～83（56.27±12.98）岁,病程2～68（14.12±11.25）个月.其中72例接受药物治疗（A组）,128例接受三维电解剖标测系统（Carto）指导下消融治疗（B组）,随访3、6个月后对两组患者的左心房结构、功能及生活质量进行比较.结果 经过3个月的随访,A组有69例完成随访,21例维持窦性心律（窦律）（30.4％）.B组有127例完成随访,108例患者维持窦律（85.0％）.独立样本t检验提示：A组的左心室收缩末期左心房最大容积指数（LAVImax）与左心室舒张末期左心房最小容积指数（LAVImin）增大,左心房射血分数（LAEF）减小;B组的LAVImax与LAVImin减小,LAEF增加.A组与B组的一般健康与生活质量明显提高,但B组提高的幅度明显高于A组,3个月后两组的一般健康与生活质量差异有统计学意义（P＜0.01）;A组与B组的心理健康评分均明显增加（P＜0.01）,但两组提高的水平差异无统计学意义.经过6个月的随访,A组的LAVImax、LAVImin较3个月前明显增大,LAEF明显减少（P＜0.05）,但B组的LAVImax,LAVImin较3个月前略有缩小,LAEF略有增加,差异无统计学意义.A组的一般健康与生活质量、心理健康评分较3个月前明显降低（P＜0.05）,但B组的一般健康与生活质量、心理健康评分与3个月前相比差异无统计学意义.结论 导管消融在改善房颤患者的左心房大小、功能及提高生活质量方面优于药物治疗.     

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。     

磁导航指导下心房颤动导管消融的临床研究

目的探讨磁导航指导下心房颤动(简称房颤)导管消融的可行性和安全性。方法对22例房颤患者穿刺房间隔后,采用盐水灌注磁消融导管行左房建模和左右肺静脉电位隔离,永久性房颤加房顶线和/或峡部线消融。消融温度前壁和后壁均设定为48℃,前壁消融能量40~45 W,后壁消融能量30~35 W,每点消融时间30~60 s或电位幅度下降80%,盐水灌注流量消融和未消融状态下分别为17 ml/min和2 ml/min。肺静脉电位隔离结束后,采用"牛眼图"确认,同时观察和记录手术操作时间、X线暴露时间、X线暴露量和手术相关并发症。结果 22例房颤患者均成功实现肺静脉电位隔离,手术操作时间(153.4±22.8)min,其中建模及肺静脉电位隔离时间(111.3±15.3)min,消融时间(33.1±5.6)min,X线暴露时间(18.2±7.7)min,X线暴露量(665.4±506.7)mGy,未发生心包压塞和栓塞等严重并发症。结论应用磁导航可成功对房颤患者进行标测和消融,且安全可行,学习曲线短。     

Effect of catheter ablation on quality of life of patients with paroxysmal atrial fibrillation

BACKGROUND: Although improved quality of life is one of the primary aims of catheter ablation for paroxysmal atrial fibrillation, there is a paucity of published data on this topic. OBJECTIVES: The purpose of this study was to determine the effect of curative catheter ablation on the quality of life of patients with symptomatic, drug-refractory paroxysmal atrial fibrillation. METHODS: This was a prospective nonrandomized study of 63 consecutively enrolled patients (49 men and 14 women, age 56 +/- 7 years). Patients were excluded from the study if they had significant structural heart disease. The ablation strategy consisted of systematic isolation of all pulmonary veins, followed by limited linear ablation in the atria comprising left isthmus ablation (between the left inferior pulmonary vein and lateral mitral annulus) and cavotricuspid isthmus ablation. Patients completed quality-of-life questionnaires comprising the SF-36 and Symptom Checklist at baseline and 3 and 12 months following ablation. RESULTS: Fifty-four patients (86%) were free of symptomatic recurrence at 12-month follow-up. Successful ablation resulted in a significant improvement of all eight subscales of the SF-36 and of symptom frequency and severity scores of the symptom checklist at 3 months. This improvement was maintained at 12 months. CONCLUSIONS: Combined pulmonary vein isolation and linear atrial ablation has a high success rate for cure of paroxysmal atrial fibrillation. Successful curative catheter ablation of paroxysmal atrial fibrillation significantly and persistently improved quality of life during long-term follow-up. This improvement in quality of life was accompanied by a significant reduction in arrhythmia symptom frequency and severity.     

阵发性心房颤动射频消融术后左房大小和机械功能变化

目的探讨经导管射频消融术对阵发性心房颤动（房颤）患者左房功能的影响,并比较肺静脉口节段性电隔离（SPVI）和环肺静脉消融（CPVA）两种术式在此方面的异同。方法66例阵发性房颤患者接受射频消融手术治疗。应用经胸心脏超声检查测量患者术前、术后1天、1个月和3个月时的左房前后径、左房面积、舒张晚期跨二尖瓣血流峰速（A峰）和舒张晚期心肌组织运动峰速（A’峰）。结果66例患者中,30例接受SPVI术,36例接受CPVA术。两组患者一般临床情况及术前超声参数相似。术后随访（315±153）d,SPVI组和CPVA组无房性心律失常复发率相似（70％与75％,P=0．650）。两组在手术后左房面积均较术前缩小,SPVI组发生于术后1个月,而CPVA组于术后3个月。SPVI组左房直径也显示出明显缩小（P〈0．05）,而CPVA组术前和术后则差异无统计学意义。左房机械功能方面,CPVA组于术后1天A峰和A’峰明显降低（P〈0．05）,两者均于3个月后较术后1天明显回升,A峰恢复至术前水平,A’峰较术前有明显升高。SPVI组术后1天没有出现A峰和A’峰明显降低;其A峰于术后1个月升高,并保持至3个月;A’峰于术后3个月时升高。结论阵发性房颤经导管SPVI术和CPVA术治疗后3个月,可以出现左房面积缩小和收缩功能改善。CPVA术比SPVI术造成了更多的左房损伤,表现为术后1天左房功能的下降以及术后左房大小、功能参数改善的延迟。     

Depression, anxiety, and quality of life in patients with atrial fibrillation

OBJECTIVE: To examine the prevalence and persistence of depression and anxiety in patients with atrial fibrillation (AF), and their effect on future quality of life (QoL) status. METHODS: The Beck Depression Inventory and State-Trait Anxiety Inventory were completed by 101 patients with AF (62 men; mean age +/- SD, 66.3 +/- 11.0 years), who were compared to 97 patients with hypertension (as "disease control" subjects) in sinus rhythm (64 men; mean age, 68.0 +/- 7.2 years) at baseline and at 6 months. QoL was ascertained at both time points using Dartmouth Care Cooperative Information Project charts. RESULTS: At baseline among AF patients, symptoms of depression, state anxiety, and trait anxiety prevailed in 38%, 28%, and 38%, respectively; analogous data for hypertensive patients were 30%, 23%, and 22%. AF patients displayed higher levels of trait anxiety (p < 0.05), with no significant differences in baseline depression, state anxiety, and QoL between patients with AF and disease control subjects. Symptoms of depression and anxiety (state and trait) persisted at 6 months in 36.8% and 33.3%, respectively. Symptoms of depression (p < 0.001) and anxiety (p < 0.001) at baseline, female gender (p = 0.01), ethnicity (p = 0.01), and employment status (p = 0.03) were significantly correlated with QoL at 6 months in the patients with AF. Multiple regression analysis revealed that baseline depression score provided the best independent prediction of 6-month QoL (R(2) = 0.20), although gender and employment status also entered the model. CONCLUSION: Approximately one third of AF patients have elevated levels of depression and anxiety, which persist at 6 months. Symptoms of depression were the strongest independent predictor of future QoL in these patients.     

Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: High recurrence rate is still a major problem associated with ablation of paroxysmal atrial fibrillation (AF). Most of the recurrences occur within 6 months after ablation. The characteristics of very late recurrent AF (>12 months after ablation) have not been reported. METHODS AND RESULTS: Two hundred seven patients with drug-refractory AF underwent successful focal ablation or isolation of AF foci. After the first ablation procedure, Holter monitoring and event recorders were used to evaluate symptomatic recurrent AF. A second ablation procedure was recommended if the antiarrhythmic drugs could not control recurrent AF. During long-term follow-up (mean 30 +/- 11 months, up to 51 months), 70 patients had recurrent AF, including 13 patients (6%) with very late (>12 months) recurrent AF (group 1) and 57 patients (28%) with late (within 12 months after ablation) recurrent AF (group 2). Group 1 patients had a significantly lower incidence of multiple (> or = 2) AF foci (23% vs 63%, P = 0.02) than group 2 patients. In addition, the incidence of antiarrhythmic drugs use (38% vs 84%, P = 0.001) to maintain sinus rhythm after the first episode of recurrent AF was significantly lower in group 1 than group 2 patients, and the incidence of a second intervention procedure (8% vs 35%, P = 0.051) tended to be lower in group 1 than group 2 patients. CONCLUSION: The incidence of very late recurrent AF after ablation of paroxysmal AF is very low, and the clinical outcome of patients with very late recurrent AF is benign.     

Asymptomatic pulmonary vein stenosis after cryoballoon catheter ablation of paroxysmal atrial fibrillation

Pulmonary vein (PV) isolation is an effective treatment option for symptomatic atrial fibrillation. PV stenosis is a well-recognized complication of radiofrequency energy application but has not been observed following cryoballoon ablation. Here, we report a case of asymptomatic PV stenosis associated with cryoballoon PV isolation, illustrating a risk that should be considered when applying this technique.     

Radiofrequency ablation of paroxysmal atrial fibrillation by mesh catheter

Introduction  Pulmonary veins isolation usually requires a multielectrode catheter for mapping in addition to the ablation catheter. We describe our experience with a new multipolar catheter designed for simultaneous mapping and ablation (MESH, Bard). Methods and results  We tested the catheter in 15 patients (mean age 61.1 ± 7.9; eight men) scheduled for paroxysmal atrial fibrillation ablation. The catheter was positioned in front of the pulmonary vein ostia. A pulmonary vein potential was demonstrated in 63.5% of the veins, which were disconnected with a mean of 1.6 radiofrequency applications with a mean time of 351 ± 125.8 s (range 180–650) for each vein. Mean procedural time was 93 ± 17.1 min (range 65–120), and fluoroscopy time was 13.7 ± 4.0 (range 5–15) min. No complications occurred during and after or procedures. Conclusion  Pulmonary veins disconnection with MESH ablator catheter is feasible with short procedural and X-ray exposure time. Further studies are needed to compare this new device to standard multipolar mapping catheters in order to evaluate its ability to correctly identify pulmonary vein potentials and to compare its safety and efficacy.     

Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: Elimination of the initiating focus within the pulmonary vein (PV) using radiofrequency (RF) catheter ablation is a new treatment modality for treatment of drug-refractory atrial fibrillation. However, information on the long-term safety of RF ablation within the PV is limited. METHODS AND RESULTS: In 102 patients with drug-refractory atrial fibrillation and at least one initiating focus from the PV, series transesophageal echocardiography was performed to monitor the effect of RF ablation on the PV. There were 66 foci in the right upper PV and 65 foci in the left upper PV. Within 3 days of ablation, 26 of the ablated right upper PVs (39%) had increased peak Doppler flow velocity (mean 130+/-28 cm/sec, range 106 to 220), and 15 of the ablated left upper PVs (23%) had increased peak Doppler flow velocity (mean 140+/-39 cm/sec, range 105 to 219). Seven patients had increased peak Doppler flow velocity in both upper PVs. No factor (including age, sex, site of ablation, number of RF pulses, pulse duration, and temperature) could predict PV stenosis after RF ablation. Three patients with stenosis of both upper PVs experienced mild dyspnea on exertion, but only one had mild increase of pulmonary pressure. There was no significant change of peak and mean flow velocity and of PV diameter in sequential follow-up studies up to 16 (209+/-94 days) months. CONCLUSION: Focal PV stenosis is observed frequently after RF catheter ablation applied within the vein, but usually is without clinical significance. However, ablation within multiple PVs might cause pulmonary hypertension and should be considered a limiting factor in this procedure.     

典型心房扑动对心房颤动导管消融复发的影响

目的 评价典型心房扑动(房扑)对心房颤动(房颤)导管消融复发的影响.方法 120例药物治疗无效的阵发性房颤患者在三维电解剖标测系统和肺静脉环状标测电极导管联合指导下行环肺静脉电隔离.其中17例(14.2%)合并典型房扑(房扑组,其余作为对照组),行三尖瓣环峡部消融,三尖瓣环峡部消融终点为三尖瓣环峡部双向阻滞.房颤复发定义为导管消融3个月后发生房性快速心律失常.结果 房扑组房颤病程(9.8±10.7)年,长于对照组(5.9±6.3)年,差异有统计学意义(P=0.036).房扑组与对照组相比,年龄、性别、合并器质性心脏病、左心房直径、左心室射血分数差异无统计学意义.随访91～401(237±79)d,房扑组房颤复发率为47.1%,对照组房颤复发率为12.6%,两组间差异有统计学意义(P=0.001).经校正年龄、房颤病程、合并器质性心脏病、左心房直径等因素,Cox多因素分析发现消融术前合并房扑是房颤复发的独立危险因素(危险比3.52,95%可信区间1.32～9.34,P=0.012).结论 典型房扑可能增加房颤导管消融术后房颤的复发,房颤导管消融前应对患者是否合并典型房扑进行认真评价.