Chen S A, Yang C J, Chiang C E, Hsia C P, Tsang W P, Wang D C, Ting C T, Wang S P, Chiang B N, Chang M S
Department of Medicine, National Yang-Ming Medical College, Taipei, Taiwan, R.O.C.
Am Heart J. 1992 Dec;124(6):1512-6. doi: 10.1016/0002-8703(92)90065-4.
Fourteen patients (mean age, 48 +/- 19 years) with left ventricular dysfunction in the absence of underlying organic heart disease underwent catheter ablation (nine with direct-current energy and five with radiofrequency energy) to treat drug-refractory, symptomatic supraventricular reentrant tachycardia (mean duration of tachycardia, 22 +/- 17 years). Clinical tachycardias were accessory pathway-mediated tachyarrhythmia (12 patients) and atrioventricular nodal reentrant tachycardia (two patients). Changes of ventricular function after successful ablation, as assessed by radionuclide ventriculography and echocardiography, showed a decrease in left ventricular end-systolic dimension (39 +/- 6 mm to 34 +/- 6 mm; 32 +/- 6 mm; p < 0.05) and in left ventricular end-diastolic dimension (55 +/- 5 mm to 52 +/- 3 mm; 51 +/- 3 mm; p < 0.05) in the early (2 to 3 months) and late (6 to 8 months) follow-up periods, increase of nuclear ejection fraction (38% +/- 8% to 46% +/- 7%; p < 0.05) and fractional shortening (28% +/- 7% to 36% +/- 8%; p < 0.05) in the late follow-up period. Increase of fractional shortening was mainly due to decrease in the end-systolic dimension. These findings suggest that prolonged attacks of uncontrolled supraventricular tachycardia may result in left ventricular dysfunction, which is reversible after successful catheter ablation of the arrhythmias.
14例（平均年龄48±19岁）无潜在器质性心脏病的左心室功能不全患者接受了导管消融治疗（9例采用直流电能量，5例采用射频能量），以治疗药物难治性、有症状的室上性折返性心动过速（心动过速平均持续时间22±17年）。临床心动过速为旁路介导的快速心律失常（12例患者）和房室结折返性心动过速（2例患者）。通过放射性核素心室造影和超声心动图评估，成功消融后心室功能的变化显示，在早期（2至3个月）和晚期（6至8个月）随访期间，左心室收缩末期内径减小（从39±6mm减小至34±6mm；32±6mm；p<0.05），左心室舒张末期内径减小（从55±5mm减小至52±3mm；51±3mm；p<0.05），晚期随访期间核射血分数增加（从38%±8%增加至46%±7%；p<0.05），缩短分数增加（从28%±7%增加至36%±8%；p<0.05）。缩短分数的增加主要归因于收缩末期内径的减小。这些发现表明，持续性未控制的室上性心动过速发作可能导致左心室功能不全，而在心律失常成功进行导管消融后，这种功能不全是可逆的。
