射频消融治疗高血压人群中室性早搏的中长期随访

目的:了解射频消融治疗高血压人群中室性早搏患者的临床疗效及手术对患者生活质量的影响。方法:在进行高血压规范化治疗并达标的基础上,对27例高血压人群中频发室性早搏患者,采用起搏标测法/激动标测法或两者结合进行标测消融,并让患者在术前和术后分别检查动态心电图、心脏超声、手术前后测定心肌钙蛋白I(cTnI),以及在手术前、手术后3月、12月分别填写SF-36调查表,量表采用标准分法进行评分、统计分析。结果:即刻成功率89%(24/27),总成功率96.3%,1例患者早搏次数较术前有明显好转,但次数仍大于3000次/d。cTnI在手术后稍升高手术前后分别为(0.15±0.19)和(1.09±0.40)μg/L,P<0.01],但仍在正常范围内;患者左心室舒张末期内径(LVEDd)手术前后分别为(44.40±5.07)mm(42.44±5.60)mm,P<0.01]、左心室收缩末期内径(LVESd)分别为(33.07±2.30)mm和(31.66±2.20)mm,P<0.01]在手术后有所缩小,可以提高左室射血分数(LVEF)分别为(56.07±1.59)%和(59.92±1.49)%,P<0.01]。患者群整体的生活质量各项指标在术后均有明显提高(P<0.01)。射频消融治疗能降低患者就医次数、医药费用(P<0.01),随访中无并发症。结论:射频消融治疗高血压人群中室早患者安全、有效,能进一步改善心功能;可显著提高患者生活质量。

Radiofrequency Catheter Ablation of Premature Ventricular Contractions in Hypertensive Patients: a Medium and Long-term Follow-up

Objective: To evaluate the medium and long-term effects of radiofrequency catheter ablation (RFCA) on the hyptensive patients with premature ventricular contractions (PVCs). Methods: Radiofrequency catheter ablation (RFCA) was performed in 27 patients. The 24-hour ambulatory electrocardiographic monitoring, echocardiography, quality of life, healthcare resources utilization and cost were assessed at a screening visit and 3 and 12 months after RFCA. Patients were treated with RFCA and followed up over 6 months as outpatients. Cardiac troponin I(cTnI) level was repeatedly checked before and after RFCA. Results: Patients’ PVCs were dramatically decreased to less than 1 000 beats per day by successful RFCA, left ventricular (LV) end-diastolic dimension (LVEDd) and end-systolic dimension (LVESd) measured by echocardiography had significant changes during the follow-up period (LV dimensions decreased significantly and LVEF increased significantly during the follow-up period as following:LVEDd: (44.40±5.07) to (42.44±5.60)mm, P<0.01; LVESd: (33.07±2.30) to(31.66±2.20) mm, P<0.01; LVEF: (56.07±1.59) to (59.92±1.49)%, P<0.01); cTnI level: (0.15±0.19) to (1.09±0.40)μg/L, P<0.01, but still in normal range. This resulted in a significant improvement in quality of life at 3 and 12 months after the procedure. There were no major complications related to the procedure. It also reduced healthcare resource utilization and cost. Conclusion: Radiofrequency catheter ablation is a safe and effective treatment for hypertensive patients with premature ventricular contractions, and it is a viable alternation to drugs in the presence of disabling symptoms, and a protective method for hypertensive patients.