Verma Atul, Kilicaslan Fethi, Adams James R, Hao Steven, Beheiry Salwa, Minor Stephen, Ozduran Volkan, Claude Elayi Samy, Martin David O, Schweikert Robert A, Saliba Walid, Thomas James D, Garcia Mario, Klein Allan, Natale Andrea
Marin General Hospital, Sutter Pacific Heart Centers, San Francisco, California, USA.
J Cardiovasc Electrophysiol. 2006 Jul;17(7):741-6. doi: 10.1111/j.1540-8167.2006.00488.x.
Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known.
To assess the impact of PVAI on LA function remotely postablation.
Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT.
Mean radiofrequency ablation time was 45 +/- 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 +/- 6% to 22 +/- 5% (P = 0.01).
Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.
尽管肺静脉前庭隔离术（PVAI）可能治愈心房颤动（AF）并改善左心房（LA）功能，但广泛的左心房消融对左心房功能的影响尚不清楚。
评估消融术后远程评估PVAI对左心房功能的影响。
连续接受PVAI的患者在消融术前和消融术后6个月进行经胸（TTE）和经食管（TEE）超声心动图检查（n = 41）或电影电子束CT（cine EBCT，n = 26）检查。仅纳入阵发性和持续性而非永久性房颤患者。所有患者均在窦性心律下进行成像。通过TTE评估左心房直径（LAD）、左心房收缩和舒张面积以及左心房面积变化分数（LFAC）。通过TEE测量二尖瓣（TMF）、左心耳（LAA）和肺静脉（PVF）的多普勒血流。TMF上的A峰、LAA排空峰值速度（LAAF）和PVF上的A峰逆转（AR）用作左心房收缩功能的替代指标。PV血流上的S峰用作储备功能的替代指标。从电影电子束CT测量左心房面积、容积和左心房射血分数（LAEF）。
平均射频消融时间为45±21分钟。所有患者的四条肺静脉均被隔离；无肺静脉狭窄病例。超声心动图显示PVAI术后LAD和左心房面积显著减小。术后A峰和AR峰也更高，而其他变量显示出明显的改善趋势。在持续性房颤患者亚组中，PVAI术后左心房大小、A峰甚至S峰均有改善（P = 0.04）。电影电子束CT显示PVAI术后左心房面积和容积均显著减小。PVAI术后LAEF也有显著改善，从17±6%提高到22±5%（P = 0.01）。
PVAI期间的广泛消融不会导致左心房功能恶化，反而可能导致长期改善，尤其是在房颤负荷较高的患者中。
