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目的:动态观察阵发性心房颤动患者射频消融术前及消融后不同时段左房结构和功能的变化,探讨射频消融术对左房功能的影响及其临床意义。方法:37例阵发性房颤患者接受左房线性消融+肺静脉电隔离术,药物治疗维持窦律的患者为对照组,平均随访(10.5±4.7)个月(3~19个月),应用超声心动图观察治疗前及治疗后不同时段左房结构及功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖瓣血流频谱,以及组织多普勒测量二尖瓣环舒张晚期运动速度(Va)。结果:①药物组20例成功维持窦律,消融治疗组26例成功维持窦律,9例复发;②药物治疗组长期维持窦性心律者左房容积有所变小,治疗后各个时期与治疗前比较差异无统计学意义。消融成功组术后左房容积逐渐减小,术后6个月时与术前水平比较有统计学差异,至12个月,无进一步缩小;与治疗前相比,治疗后12月左房前后径、左右径及上下径皆有统计学差异。消融后复发组6个月时未见明显变化;③消融治疗后1月,LAAEF、A-VTI、VA及AFF均与术前有统计学差异,至随访12月恢复至治疗前水平。消融治疗后心房侧的心肌组织运动速度Va皆有一定程度的降低。结论:左房线性消融是治疗阵发性房颤的有效方法,消融成功者可一定程度逆转左房结构重构,复发者无明显变化;射频消融引起左房局部收缩功能降低。
OBJECTIVE: To dynamically observe the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation before radiofrequency ablation and at different time after ablation, and to investigate the effect of radiofrequency ablation on left atrial function and its clinical significance. Methods: Thirty-seven patients with paroxysmal atrial fibrillation underwent left atrium linear ablation and pulmonary vein isolation and the patients undergoing drug therapy to maintain sinus rhythm were selected as control group. The average follow-up was (10.5 ± 4.7) months (range, 3-9 months) Echocardiography before and after treatment to observe changes in left atrial structure and function of the left and right atrium measured by M-mode and two-dimensional ultrasound, Doppler measurement of mitral flow spectrum, and tissue Doppler measured two-pointed Annulus late diastolic velocity (Va). Results: ① In the drug group, sinus rhythm was successfully maintained in 20 patients. In the ablation group, 26 patients successfully maintained the sinus rhythm and 9 patients relapsed. ② The left atrial volume of the drug-treated group decreased slightly after prolonged sinus rhythm. After treatment, Before the difference was not statistically significant. After ablation, the volume of left atrium decreased gradually, and there was a significant difference compared with preoperative level at 6 months after operation. No significant reduction was found at 12 months. Compared with before treatment, Diameter, left and right diameter and diameter were statistically different. At 6 months after ablation, there was no significant change in LAAEF, A-VTI, VA and AFF at the 6th month after ablation. All patients were followed up for 12 months and returned to pre-treatment level. After ablation, the atrial side of the myocardial tissue velocity Va are reduced to some extent. Conclusions: Left atrium linear ablation is an effective method for the treatment of paroxysmal atrial fibrillation. Successful ablation can reverse left atrial structural remodeling to a certain degree without any significant changes in recurrence. Local ablation of left atrium after radiofrequency ablation is reduced.