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目的对照研究左房线性消融及药物治疗阵发性心房颤动对患者左房血流动力学的影响及转归,并探讨影响因素。方法选择在我院接受左房线性消融术或单纯抗心律失常药物治疗的阵发性房颤患者,根据治疗方法分为:左房线性消融组(消融组)和单纯药物治疗组(药物组);分别于治疗前、治疗后1周内、1、3和6个月时应用心脏超声测量左房内径大小及二尖辦和肺静脉口血流动力学的变化;观察消融组和药物组左房前后径、左右径和上下径的变化,频谱多普勒测量二尖辦E波、A波峰速度(VE、VA)和速度时间积分(E-VTI、A-VTI),并计算左房充盈分数(AFF)和左房射血力(AEF);测量右上肺静脉口S波、D波及负向a波的速度峰值(VS、VD和Va)和速度时间积分(S-VTI、D-VTI和a-VTI),计算Vs/ND、S／D-VTI和肺静脉前向血流收缩分数(PSF)。结果38例阵发性心房颤动患者,分别经两种方法治疗后,窦性心律得以长期维持,无血栓栓塞事件发生。两组分别随访(11．8±5．9)个月和(7．1±3．3)个月,两组患者在年龄、性别比、发病时间和基础疾病构成方面的差异均无统计学主义(P值均>0．05)。两组患者治疗前左房内径基线水平无差异。消融组术后6个月时左房前后径和左右径明显减小[与术前比较,(37．6±3．30)cm比(39．8±3．33)cm,(39．6±3．34)cm比(42．9±6．65)cm,P值均<0．05],药物组在治疗过程中有减小趋势,但差异无统计学意义(P>0．05)。消融组和药物组治疗前、后二尖瓣和肺静脉频谱各指标的差均无统计学意义(P值均>0．05);消融组在术后1周内代表左房收缩功能的VA、A-VTI、AFF、AEF、Va和代表左房舒张功能的VS、S-VTI、Vs /ND、S／D-VTI及PSF均较术前明显降低(P值均<0．05),与同一时期药物组以上各指标的差异有统计学意义;随时间推移逐渐恢复,术后3个月、6个月时与术前及同一时期药物组的差异均无统计学意义(P值均>0．05)。VD和D-VTI在两组间或两组内的差异始终无统计学意义(P值均>0．05)。结论左房线性消融术后左房血流动力学逐渐好转,左房收缩功能的转归与是否维持窦律相关,消融对收缩功能的影响在术后逐渐恢复,至6个月时消除;与药物治疗相比,维持窦律消融组左房收缩功能的长期疗效更佳。
Objective To study the effects of left atrium linear ablation and pharmacotherapy for paroxysmal atrial fibrillation on left atrium hemodynamics in patients and to explore the influencing factors. Methods Patients with paroxysmal atrial fibrillation undergoing left atrium linear ablation or antiarrhythmic drug treatment in our hospital were divided into two groups according to the treatment: left atrial linear ablation group (ablation group) and simple drug treatment group (drug group) ; Before treatment, within 1 week after treatment, 1, 3 and 6 months when the application of cardiac ultrasound measured left atrial diameter and mitral and pulmonary vein osmolarity changes; observed ablation group and drug group left atrium Left and right diameter and upper and lower diameter changes, Doppler E wave, A peak velocity (VE, VA) and velocity-time integral (E-VTI, A-VTI) were measured by spectral Doppler, and left atrial filling fraction (AFF) and left atrial ejection (AEF). The peak velocity (VS, VD and Va) and velocity time integral (S-VTI, D-VTI and a -VTI) to calculate Vs / ND, S / D-VTI, and pulmonary venous forward flow fraction (PSF). Results 38 cases of patients with paroxysmal atrial fibrillation, respectively, after two methods of treatment, sinus rhythm to be long-term maintenance, no thromboembolic events. The two groups were followed up for (11.8 ± 5.9) months and (7.1 ± 3.3) months, respectively. There was no significant difference in the age, sex ratio, onset time and underlying disease between the two groups Doctrine (P> 0.05). There was no difference in baseline left atrial diameter between the two groups before treatment. At 6 months after operation, the anteroposterior diameter, left and right diameter of the left atrium were significantly decreased in the ablation group [(37.6 ± 3.30) cm vs (39.8 ± 3.33) cm, (39.6 ± 3.33) cm ± 3.34) cm (42.9 ± 6.65) cm, both P <0.05]. The drug group showed a decreasing trend during the treatment, but the difference was not statistically significant (P> 0.05 ). There was no significant difference in mitral and pulmonary venous parameters between the ablation group and the drug group before and after treatment (P> 0.05). In the ablation group, the left atrial systolic function VA, A-VTI, AFF, AEF, Va and VS, S-VTI, Vs / ND, S / D-VTI and PSF representing left atrial diastolic function were significantly lower than those preoperatively The differences of the above indexes in the same period were statistically significant, gradually recovered with the passage of time, and there was no significant difference between the groups before and 3 months and 6 months after operation (P < 0.05). The differences in VD and D-VTI between the two groups or in both groups were not statistically significant (P> 0.05). Conclusions Left atrium hemodynamics improved gradually after left atrial ablation, and the outcome of left atrial systolic function correlated with the maintenance of sinus rhythm. The effect of ablation on systolic function recovered gradually after operation and was eliminated by 6 months. Compared with drug treatment, long-term efficacy of left atrial systolic function in maintaining sinus rhythm ablation group was better.