对于永久性心房颤动患者，收缩储备的存在对房室结消融术后左心室功能的演变没有预测价值。

The presence of contractile reserve has no predictive value for the evolution of left ventricular function following atrio-ventricular node ablation in patients with permanent atrial fibrillation.

作者信息

Szili-Torok Tamas, Bountioukos Manos, Muskens Agnes J Q M, Theuns Dominic A M J, Poldermans Don, Roelandt Jos R T C, Jordaens Luc J

机构信息

Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.

出版信息

Eur J Echocardiogr. 2005 Oct;6(5):344-50. doi: 10.1016/j.euje.2004.12.001.

DOI:10.1016/j.euje.2004.12.001

PMID:15975852

Abstract

AIMS

Transcatheter ablation of the atrio-ventricular (AV) node followed by ventricular pacing has been shown to improve symptoms and quality of life (QOL) of patients with permanent atrial fibrillation (AF). In a considerable number of patients, cardiac function deteriorates after AV node ablation. We aimed to determine whether the absence of contractile reserve assessed by low dose dobutamine stress echocardiography (LDDSE) could identify those patients whose left ventricular (LV) function deteriorates after AV node ablation.

METHODS

All 25 patients studied had permanent AF for at least 12 months. LVEF was determined 6 days and 3 months after AV node ablation by radionuclide ventriculography (RNV), at a paced rate of 80 beats/min. Deterioration in cardiac function was defined as a decrease in LVEF>5%. LDSE was performed in all patients before and after ablation. The presence of contractile reserve was defined as an improvement in regional function of >or=1 grade at low dose dobutamine in at least 4 segments. QOL measurements were taken using Minnesota, NHBP and MPWB questionnaires.

RESULTS

LVEF showed no improvement in the overall group (52.8+/-11.1% vs. 51.8+/-9.8%, p=NS). QOL showed significant improvement in all questionnaires (Minnesota: 4.1+/-2.1 vs. 2.5+/-2, p=0.001; NHBP: 54.8+/-43.3 vs. 34.2+/-34.3, p=0.002; MPWB: 22.2+/-4.6 vs. 19.4+/-6.2, p=0.03). There was no significant difference in change of LVEF between patients with and without contractile reserve (-0.4+/-8.7 vs. 1.6+/-11.3, p=NS). However, patients with a preserved LVEF at baseline showed more frequently a reduced LVEF after AV node ablation (62.2+/-10.4% vs. 47.5+/-7.6%, p=0.001).

CONCLUSIONS

(1) The absence of contractile reserve does not predict deterioration of cardiac function after AV node ablation. (2) AV node ablation results in a significant improvement in QOL, which is not necessarily associated with improvement of LVEF. (3) Higher baseline LVEF predicts deterioration of cardiac function. These data suggest that although AV node ablation is an excellent way of controlling symptoms, it should be avoided in patients with normal LV function.

摘要

目的

经导管消融房室（AV）结并随后进行心室起搏已被证明可改善永久性心房颤动（AF）患者的症状和生活质量（QOL）。在相当数量的患者中，AV结消融后心脏功能会恶化。我们旨在确定通过低剂量多巴酚丁胺负荷超声心动图（LDDSE）评估的收缩储备缺失是否能识别出那些AV结消融后左心室（LV）功能恶化的患者。

方法

所研究的25例患者均患有永久性AF至少12个月。在AV结消融后6天和3个月通过放射性核素心室造影（RNV）测定左心室射血分数（LVEF），起搏频率为80次/分钟。心脏功能恶化定义为LVEF下降>5%。所有患者在消融前后均进行LDDSE。收缩储备的存在定义为在低剂量多巴酚丁胺作用下至少4个节段的局部功能改善≥1级。使用明尼苏达、NHBP和MPWB问卷进行QOL测量。

结果

总体组的LVEF无改善（52.8±11.1%对51.8±9.8%，p=无显著性差异）。所有问卷的QOL均有显著改善（明尼苏达：4.1±2.1对2.5±2，p=0.001；NHBP：54.8±43.3对34.2±34.3，p=0.002；MPWB：22.2±4.6对19.4±6.2，p=0.03）。有收缩储备和无收缩储备的患者之间LVEF的变化无显著差异（-0.4±8.7对1.6±11.3，p=无显著性差异）。然而，基线时LVEF正常的患者在AV结消融后LVEF降低更为常见（62.2±10.4%对47.5±7.6%，p=0.001）。