成功的射频消融术可确定房室重构并改善组织多普勒成像时的心脏舒张和收缩功能。

Successful radiofrequency ablation determines atrio-ventricular remodelling and improves systo-diastolic function at tissue Doppler-imaging.

作者信息

Onorati Francesco, Bilotta Massimo, Borrello Francesco, Vatrano Marco, di Virgilio Antonio, Comi Maria Caterina, Perticone Francesco, Renzulli Attilio

机构信息

Cardiac Surgery Unit-Magna Graecia University of Catanzaro, Catanzaro, Italy.

出版信息

Eur J Cardiothorac Surg. 2007 Mar;31(3):414-21; discussion 421-2. doi: 10.1016/j.ejcts.2006.11.045. Epub 2007 Jan 16.

DOI:10.1016/j.ejcts.2006.11.045

PMID:17223350

Abstract

BACKGROUND

Clinical, echocardiographic results and determinants of atrial fibrillation (AF) recurrence following AF ablation during mitral valve surgery (AFAMVS) were evaluated.

METHODS

Fifty-two patients undergoing radiofrequency AFAMVS between January 2003 and December 2005, underwent serial echocardiographies with tissue Doppler imaging to assess atrio-ventricular function. Recurrence of AF, hospital readmission, episodes of congestive heart failure (CHF) were recorded. Predictors for AF-recurrence were evaluated.

RESULTS

At a 29.5+/-8.6 months of follow-up (100% complete), 78.8% patients were in sinus rhythm (SR). Freedom from AF-recurrence was 64.6+/-0.76%, from hospital readmission 88.9+/-0.47%, from CHF 91.6+/-0.63%. SR-patients demonstrated better freedom from hospital readmission (97.4 vs 60.6%; p=0.0003) and from CHF (100 vs 72.7%; p=0.008) during follow-up. At follow-up SR-patients demonstrated left atrial (preoperative 5.8+/-0.8 cm vs follow-up 5.1+/-0.9; p=0.013) and ventricular reverse remodelling (preoperative LVDd 5.7+/-1.1cm vs follow-up 5.2+/-1.1; p=0.048 - preoperative LVDs 4.0+/-1.4 vs follow-up 3.6+/-1.1; p=0.036). E/A ratio was normal in 73.1% (92.7% of SR-patients). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) of SR-patients, compared with AF-patients (Sm 9.40+/-1.74 vs 7.72+/-1.5, p=0.0001; Em: 10.45+/-1.98 vs 7.68+/-0.72, p=0.001; E/Em: 0.07+/-0.02 vs 0.10+/-0.04, p=0.0001). Large preoperative atrial diameter (OR=5.81; p=0.002), preoperative NYHA-IV (OR=3.55; p=0.001), high diuretics at discharge (OR=1.27; p=0.03), tricuspid insufficiency at follow-up (OR=2.31; p=0.02) were independent predictors of AF-recurrence.

CONCLUSIONS

Radiofrequency AFAMVS achieves 78.8% of SR recovery. Maintenance of SR improves clinic, haemodynamic and echocardiographic endpoints. Pre- and post-operative cardiac failure is the main determinant of AF-recurrence.

摘要

背景

评估二尖瓣手术期间房颤消融（AFAMVS）后房颤（AF）复发的临床、超声心动图结果及相关决定因素。

方法

2003年1月至2005年12月期间接受射频AFAMVS的52例患者，采用组织多普勒成像进行系列超声心动图检查以评估房室功能。记录房颤复发、再次入院、充血性心力衰竭（CHF）发作情况。评估房颤复发的预测因素。

结果

在29.5±8.6个月的随访期（100%完整），78.8%的患者处于窦性心律（SR）。无房颤复发率为64.6±0.76%，无再次入院率为88.9±0.47%，无CHF率为91.6±0.63%。SR患者在随访期间无再次入院率（97.4%对60.6%；p = 0.0003）和无CHF率（100%对72.7%；p = 0.008）表现更佳。随访时，SR患者显示左心房（术前5.8±0.8 cm对随访5.1±0.9；p = 0.013）和心室逆向重构（术前左室舒张末期内径5.7±1.1 cm对随访5.2±1.1；p = 0.048 - 术前左室收缩末期内径4.0±1.4对随访3.6±1.1；p = 0.036）。E/A比值在73.1%（SR患者中的92.7%）正常。与房颤患者相比，左外侧瓣环水平的组织多普勒成像显示SR患者左心室收缩（Sm）和舒张（Em，E/Em）改善（Sm 9.40±1.74对7.72±1.5，p = 0.0001；Em：10.45±1.98对7.68±0.72，p = 0.001；E/Em：0.07±0.02对0.10±0.04，p = 0.0001）。术前心房直径大（OR = 5.81；p = 0.002）、术前纽约心脏协会心功能IV级（OR = 3.55；p = 0.001）、出院时利尿剂用量大（OR = 1.27；p = 0.03）、随访时三尖瓣关闭不全（OR = 2.31；p = 0.02）是房颤复发的独立预测因素。