[心室起搏器植入（VVIR）及射频房室结消融治疗药物难治性心房颤动后长期随访中的左心室收缩功能、起搏QT离散度、运动耐量及生活质量]

[Left ventricular systolic function, paced QT dispersion, exercise tolerance and quality of life in long term follow up after ventricular pacemaker implantation (VVIR) and radiofrequency atrioventricular junction ablation in drug refractory atrial fibrillation].

作者信息

Lelakowski Jacek, Małecka Barbara, Bednarek Jacek, Bigaj Jolanta

机构信息

Collegium Medicum Uniwersytetu Jagiellońskiego, Klinika Elektrokardiologii, Instytut Kardiologii, Krakowski Szpital Specjalistyczny.

出版信息

Pol Merkur Lekarski. 2008 Mar;24(141):190-4.

PMID:18634282

Abstract

UNLABELLED

THE AIM OF THE STUDY was to analyze left ventricular systolic function and dimensions, paced QT dispersion (QTD), exercise tolerance (six minute walk test- M6) and quality of life (QOL) after RFAVJ in a 6-month (6m) and a 24-month (24m) follow-up.

MATERIAL AND METHODS

RFAVJ was performed in 30 pts (18 men and 12 women) aged from 43 to 81 years (mean age 69.8+/-11.3). AF was first diagnosed from 2 to 9 (mean 5+/-2.1) years prior to ablation. All patients received VVIR pacemakers. Pacing rate was programmed at 80 bpm. Prior to RFAVJ all patients underwent: transthoracic echocardiography (ECHO) to assess the left ventricular ejection fraction (EF), ventricular end-diastolic and end-systolic dimension (LVDD, RVDD, LVSD, respectively) and left atrial dimension; QOL assessment based on self-evaluation using: a questionnaire of the SF-36, Manolis, DASI scale. M6 on flat surface. These examinations were repeated at 6m and 24m after ablation. The maximum QT interval (QTM), minimum QT interval (QTm) and QTD were measured from the 12-lead ECG after RFAVJ on the first day (1d) and at 6m, 24m following RFAVJ.

RESULTS

SF total increased from 73.4 to 96.3 (p < 0.0025) in 6m, and to 113.8 (ns) in 24m, symptomatic score from 15.7 to 20.8 (p < 0.025) in 6m, and to 22.4 (ns) in 24m, DASI from 39.3 to 46.1 (p < 0.01) in 6m and decreased to 23.9 (p < 0.001) in 24m. Any significant changes in EF and the remaining ECHO parameters in 6m were observed. At 24 m we found significant decreased in EF (p < 0.01) and increased in LVSD (p < 0.05). Parameters of the M6 significantly improved. A significant correlation was observed between the SF-36 and functional symptomatology and DASI in 6m. The mean QTm, QTM and QTD were unchanged.

CONCLUSIONS

In pts with drug refractory AF, RFAVJ and VVIR significantly improve QOL and M6. 2. At long term follow up a significant decrease in EF and increase in LVSD were demonstrated. 3. No significant changes in the paced QT and QTD were observed.

摘要

未标注

本研究的目的是分析射频消融房室结交界区（RFAVJ）后6个月（6m）和24个月（24m）随访时的左心室收缩功能和尺寸、起搏QT离散度（QTD）、运动耐量（六分钟步行试验-M6）和生活质量（QOL）。

材料与方法

对30例年龄在43至81岁（平均年龄69.8±11.3岁）的患者（18例男性和12例女性）进行RFAVJ。房颤首次诊断时间为消融术前2至9年（平均5±2.1年）。所有患者均接受VVIR起搏器。起搏频率设定为80次/分钟。在RFAVJ之前，所有患者均接受：经胸超声心动图（ECHO）以评估左心室射血分数（EF）、心室舒张末期和收缩末期尺寸（分别为LVDD、RVDD、LVSD）以及左心房尺寸；基于自我评估的QOL评估，使用：SF-36问卷、马诺利斯问卷、DASI量表。在平坦表面进行M6测试。这些检查在消融术后6m和24m重复进行。在RFAVJ术后第一天（1d）以及术后6m、24m时，从12导联心电图测量最大QT间期（QTM）、最小QT间期（QTm）和QTD。

结果

6m时SF总分从73.4增加至96.3（p<0.0025），24m时增至113.8（无统计学意义）；症状评分6m时从15.7增至20.8（p<0.025），24m时增至22.4（无统计学意义）；DASI评分6m时从39.3增至46.1（p<0.01），24m时降至23.9（p<0.001）。6m时未观察到EF及其他ECHO参数有任何显著变化。在24m时，我们发现EF显著降低（p<0.01），LVSD增加（p<0.05）。M6参数显著改善。6m时，SF-36与功能症状和DASI之间存在显著相关性。平均QTm、QTM和QTD无变化。