CAJ | 학술논문

目的：观察并比较环肺静脉隔离( CPVI)和线性消融,基础上结合或不结合心房碎裂电位( CFAEs)消融治疗持续性心房颤动( PAF)术后患者左心房结构和功能的变化。方法入选2010年10月至2012年10月在青岛大学医学院附属医院诊断为PAF患者69例,分别行CPVI+CFAEs+线性( Linear)消融( A组)或CPVI+Linear消融( B组)治疗,于术前、术后12个月行超声心动图检查,并根据随访结果进一步分为治疗有效组( A1组与 B1组)、复发组( A2组与 B2组),测量并比较左心房容积(LAV)、二尖瓣环舒张晚期峰值速度(Va),并使用二维斑点追踪成像(2D-STI)技术测量并比较A1组和B1组患者左心房各壁的收缩期、舒张早期、舒张晚期左心房峰值应变率( SRs、SRe、SRa)。结果60例患者完成随访,结果如下：①A1组与B1组的LAV与本组术前比较明显减小,Va明显升高( P<0．05)；A2组与B2组的LAV、Va与本组术前比较,差异无统计学意义(P>0．05)；②术后12个月,B1组的LAV、Va与A1组比较,差异无统计学意义；③术后12个月, B1组的前壁、下壁的 SRs、SRa 均高于 A1组( P<0．05)。结论不同术式治疗PAF有效者均可以使其LAV减小,左心房总体功能改善,虽然两组治疗有效者之间比较差异无统计学意义,但通过2D-STI观察发现,CPVI+Linear消融治疗有效者的左心房前壁、下壁的收缩与舒张功能优于结合CFAEs消融的患者。
목적：관찰병비교배폐정맥격리( CPVI)화선성소융,기출상결합혹불결합심방쇄렬전위( CFAEs)소융치료지속성심방전동( PAF)술후환자좌심방결구화공능적변화。방법입선2010년10월지2012년10월재청도대학의학원부속의원진단위PAF환자69례,분별행CPVI+CFAEs+선성( Linear)소융( A조)혹CPVI+Linear소융( B조)치료,우술전、술후12개월행초성심동도검사,병근거수방결과진일보분위치료유효조( A1조여 B1조)、복발조( A2조여 B2조),측량병비교좌심방용적(LAV)、이첨판배서장만기봉치속도(Va),병사용이유반점추종성상(2D-STI)기술측량병비교A1조화B1조환자좌심방각벽적수축기、서장조기、서장만기좌심방봉치응변솔( SRs、SRe、SRa)。결과60례환자완성수방,결과여하：①A1조여B1조적LAV여본조술전비교명현감소,Va명현승고( P<0．05)；A2조여B2조적LAV、Va여본조술전비교,차이무통계학의의(P>0．05)；②술후12개월,B1조적LAV、Va여A1조비교,차이무통계학의의；③술후12개월, B1조적전벽、하벽적 SRs、SRa 균고우 A1조( P<0．05)。결론불동술식치료PAF유효자균가이사기LAV감소,좌심방총체공능개선,수연량조치료유효자지간비교차이무통계학의의,단통과2D-STI관찰발현,CPVI+Linear소융치료유효자적좌심방전벽、하벽적수축여서장공능우우결합CFAEs소융적환자。
Objective To observe and compare the functional and structural changes of the left atrium after treated with CPVI plus atrial linear ablation combined with complex fractionated atrial electrograms (CFAEs) ablation or not in patients with persistent atrial fibrillation (PAF). Methods Sixty-nine patients with PAF were treated with CPVI+CFAEs+Linear ablation( group A) or CPVI+Linear ablation( group B) . After 12 months of follow-up,the two groups were divided into the effectively controlled group( group A1 and group B1 ) and the recurrence group ( group A2 and group B2 ) according to the clinical effects. The left atrial volume (LAV),peak atrial systolic mitral annulus velocity (Va) were measured by echocardiography before and 12 months after the ablation, respectively. The average peakstrain rate of systolic, early and late diastolic phase ( SRs,SRe,SRa) of the different left atrial walls were calculated by two-dimensional speckle tracking imaging (2D-STI)in patients of group A1 and group B1. Results Sixty patients completed the follow-up of(12. 45± 2. 05)months. The results were as follows:①About 12 months after the ablation,the LAV decreased and the Va increased compared with that before ablation in both group A1 and B1,(P<0. 05);while the difference had no statistical significance in group A2 and B2(P>0. 05).②About 12 months after ablation,the difference of the LAV and Va between group B1 and A1 had no statistical significance(P>0. 05).③About 12 months after abla-tion,the SRs and SRa of the anterior and inferior wall of the left atrium were higher in group B1 compared with that in group A1(P<0. 05). Conclusion Left atrium reversal remodeling and functional improvement occurred in the patients with PAF treated effectively with either of the two different ablation strategies,while no statistical significance was found between the two groups 12 months after the procedure. The systolic and diastolic func-tions of the anterior and inferior wall of the left atrium were better in the CPVI+Linear group measured by 2D-STI.