环肺静脉消融术治疗阵发性房颤对左房功能早期影响的探究

摘 要

环肺静脉消融术治疗阵发性房颤对左房功能

早期影响的研究

研究生：朱建兵导师：汤宝鹏

摘要

目的：应用超声心动图评价环肺静脉消融术对阵发性房颤患者左房结构和功能早期的影响。方法：选择68例Carto系统标测指导下行环肺静脉消融术的阵发性房颤患者，应用超声心动图测定其消融术前及术后1～2 d、1个月、3个月静息时窦性心律下左心房容积指标、二尖瓣血流频谱A峰流速(V A)、A峰速度时间积分(A-VTI)、E峰流速(V E) 、E峰速度时间积分(E-VTI)，计算左心房充盈分数(LAFF)和左心房射血力(LAEF),将结果进行统计学分析。结果：反映左房辅泵功能的指标左心房最小容积、左心房主动排空容积、左心房主动排空分数、A波速度峰值、A峰的速度时间积分及左心房射血力术后3月与术前比较显著下降；反映左心房管道功能的左心房管道容积术后3月明显增加；反映左心房储存功能的指标左心房最大容积、左心房总排空容积及左心房总排空分数手术前后无明显变化。结论：环肺静脉射频消融术对左房近期功能有不利影响。

关键词：心房颤动；环肺静脉消融术；左房功能

新疆医科大学医学硕士学位论文

Effect of circumferential pulmonary vein ablation for atrial fibrillation on left atrial function early

Postgraduate:Zhu Jianbing Supervisor:Tang Baopeng

Abstract

Objective: To evaluate the effects of circumferential pulmonary vein ablation with the application of echocardiography for paroxysmal atrial fibrillation in patients on left atrial(LA) structure and function early.Methods:sixty eight patients who underwent circumferential pulmonary vein ablation guided by Carto mapping system for paroxysmal atrial fibrillation were studied. Before ablation, echocardiography parameters including LA maximum volume(LA Vmax),LAp-wave volume (LA Vp),LA minimum volume LA Vmin),peak velocity of mitra lwave(Va), LA active emptying volume (LAAEV= LA V-LA Vmin),LA active empyting fraction (LAAEF = LAAEV/LA Vp), LA conduit volume[LACV = LVSV-(LA Vmax-LA Vmin)], LA total emptying volume (LATEV = LA Vmax-LA Vmin),LA total emptying fraction(LATEF= LATEV/LA Vmax) and LA ejection force [LAEF=(1/2)×ρ×MV A ×(V A2)] were measured at rest during sinus rhythm as indicators of LA function. One day to two days after ablation, one months and three months after ablation, those parameters were measured again.The changes of parameters of LA function were analyzed before and post ablation. Result: Compared with pre-ablation, the changes of LA pump function such as LAEF[(15.20±3.45) kdaynes VS (13.07±3.22) kdaynes], A peak velocity time integral (A-VTI)[(4.35±1.02)cm vs (3.29±1.32)cm], Va[(61.0±11.2) cm/s vs (52.6±10.2)cm/s], LA active emptying volume (7.68±2.79) cm3 vs (5.56±3.04) cm3], LA active empyting fraction[(0.40±0.18) vs (0.30±0.16)] decreased significantly 3 month after ablation; the indicator of left atrial conduit function LA conduit volume [(23.50±3.57) cm3 vs (28.10±3.56) cm3] increased significantly post ablation; the indicator of left atrial reservoir function such as LA total emptying volume[(14.56±3.19) cm3 vs (13.62±2.38) cm3],LA maximal volume [(34.63±5.27) cm3 vs (32.73±4.83) cm3] have no significant difference. Conclusions:he circumferential pulmonary vein ablation have negative impact on the left atrial function in the near future.

Key wors: atrial fibrillation; circumferential pulmonary vein ablation; left atrial function