CAJ | 학술논문

目的应用组织多普勒技术分析导管消融术后阵发性心房颤动(房颤)患者左心房结构和功能的变化.方法 32例阵发性房颤患者(房颤组)在Ensite NvaX三维标测系统下,完全肺静脉电解剖隔离,应用超声心动图于手术前和术后24 h、1周、1个月测量左心房内径及容积、二尖瓣跨瓣压差,多切面测定二尖辩环舒张早期和晚期运动峰值速度,取平均值并计算其比值;以同年龄组非心房颤动志愿者32例为对照(对照组).结果房颤组均达到完全肺静脉隔离,随访1个月无复发;房颤组患者术前左心房内径及容积均大于对照组(P均<0.01),术后24 h左心房容积较术前扩大(P<0.05),术后1周缩小(P<0.05),术后1个月与时照组比较,差异无统计学意义(P>0.05);二尖瓣环晚期运动峰值速度房颤组术前较对照组减低(P<0.01),术后24 h较术前减低(P<0.05),1周后增加(P<0.05或P<0.01),1个月后与对照组比较差异无统计学意义(P>0.05).结论导管消融术是治疗阵发性房颤的有效方法 ,术后24 h左心房有所扩张、收缩功能减低,但1周好转,1个月时接近术前,可能与消融对左心房损伤后修复过程有关,提示术后应重视血栓的风险和手术的损伤.
목적 응용조직다보륵기술분석도관소융술후진발성심방전동(방전)환자좌심방결구화공능적변화.방법 32례진발성방전환자(방전조)재Ensite NvaX삼유표측계통하,완전폐정맥전해부격리,응용초성심동도우수술전화술후24 h、1주、1개월측량좌심방내경급용적、이첨판과판압차,다절면측정이첨변배서장조기화만기운동봉치속도,취평균치병계산기비치;이동년령조비심방전동지원자32례위대조(대조조).결과 방전조균체도완전폐정맥격리,수방1개월무복발;방전조환자술전좌심방내경급용적균대우대조조(P균<0.01),술후24 h좌심방용적교술전확대(P<0.05),술후1주축소(P<0.05),술후1개월여시조조비교,차이무통계학의의(P>0.05);이첨판배만기운동봉치속도방전조술전교대조조감저(P<0.01),술후24 h교술전감저(P<0.05),1주후증가(P<0.05혹P<0.01),1개월후여대조조비교차이무통계학의의(P>0.05).결론 도관소융술시치료진발성방전적유효방법 ,술후24 h좌심방유소확장、수축공능감저,단1주호전,1개월시접근술전,가능여소융대좌심방손상후수복과정유관,제시술후응중시혈전적풍험화수술적손상.
Objective To investigate the left atrium (LA) function and structure changes in the paroxysmal atrial fibrillation (AF) patients after catheter ablation using tissue Doppler imaging. Methods After complete pul-monary vein, radiofrequency ablation guided by Ensite NavX System, LA systolic function and LA diameter, volume, mean mitral gradient and mitral annulus early and advanced diastolic peak velocity were assessed in 32 cases of par-oxysmal AF patients,which were compared with age-matched controls before and after 24 hours, 1 week, 1 month) AF ablation. Results AF did not occur again in 32 AF paroxysmal patients after isolation. LA diameter and volume in AF groups before ablation were larger than controls(P<0.01), which were also larger 24 hours after ablation than before (P>0.05 ), but LA volume was larger than before (P<0.05), and decreased in I week after ablation (P< 0.05), but had no significant difference compared with controls in 1 month(P>0.05 ) ;mitral annulus advanced di-astolic peak velocity decreased in AF groups before ablation (P<0.01 )and was lower than that 24 hours after cathe-ter ablation (P<0.05 ), but increased after 1 week (P<0.05 or P <0.01 ), and had no significance after 1 month. Conclusion Catheter ablation is the effective way to manage AF because LA is distended and atrial systolic func-tion is reduced within 24 hours after procedure, then gradually increased in a week and will nearly recover to that be-fore procedure in a month, which may be correlated with LA repair, implicating that postprocedural thromboembollc risk and procedure injury should be taken into consideration.