Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Heart. 2010 Aug;96(16):1275-80. doi: 10.1136/hrt.2009.188722.
Improvement of left ventricular ejection fraction (LVEF) after radiofrequency catheter ablation (RFCA) of frequent premature ventricular contractions (PVCs) has been reported. However, most patients with frequent PVCs have a normal LVEF. In these patients subtle and early forms of PVC-induced left and right ventricular (RV) impairment may not be detected by standard echocardiographic techniques.
To assess the effect of frequent PVCs on ventricular function in patients with preserved LVEF.
49 patients (30 male, 49+/-16 years) with recent-onset (median 1.2 years), frequent PVCs (burden 26+/-13%) and 25 healthy controls were studied. Thirty-four patients with PVCs underwent successful RFCA. Two-dimensional echocardiography was performed at baseline and follow-up. LV volumes and LVEF were calculated by Simpson's rule. Tricuspid annulus plane systolic excursion and fractional area change were calculated to assess RV function. Multidirectional LV strain (radial, circumferential, longitudinal) and RV free-wall longitudinal strain were calculated by two-dimensional speckle tracking imaging. At baseline LVEF, volumes and RV dimensions were normal in patients and controls.
Speckle tracking imaging demonstrated reduced LV and RV strain in patients with PVC as compared with controls. At follow-up there were no changes in LVEF, LV volumes and RV dimensions and function in patients successfully treated by RFCA and untreated patients. However, radial, circumferential and longitudinal strain improved significantly in patients after RFCA but remained unchanged in untreated patients.
Frequent PVCs can induce subtle cardiac dysfunction detected by speckle tracking imaging analysis in patients without apparent cardiomyopathy. RFCA can successfully eliminate PVCs and improve cardiac function.
射频导管消融（RFCA）治疗频发室性早搏（PVCs）后左心室射血分数（LVEF）改善已有报道。然而，大多数频发 PVCs 的患者 LVEF 正常。在这些患者中，标准超声心动图技术可能无法检测到细微和早期的 PVC 引起的左、右心室（RV）损伤。
评估频发 PVCs 对 LVEF 正常患者心室功能的影响。
49 名新发（中位时间 1.2 年）、频发 PVCs（负荷 26+/-13%）的患者（30 名男性，49+/-16 岁）和 25 名健康对照者纳入研究。34 例 PVCs 患者行 RFCA 成功。基线和随访时行二维超声心动图检查。采用 Simpson 法则计算左室容积和 LVEF。通过三尖瓣环平面收缩期位移和节段面积变化计算评估 RV 功能。通过二维斑点追踪成像计算多方向 LV 应变（径向、圆周、纵向）和 RV 游离壁纵向应变。基线时患者和对照组的 LVEF、容积和 RV 尺寸均正常。
与对照组相比，斑点追踪成像显示 PVC 患者的 LV 和 RV 应变降低。随访时，RFCA 成功治疗和未治疗患者的 LVEF、LV 容积和 RV 尺寸及功能均无变化。然而，RFCA 后患者的径向、圆周和纵向应变显著改善，而未治疗患者的应变无变化。
频发 PVCs 可引起无明显心肌病患者的心脏功能轻微改变，通过斑点追踪成像分析可检测到。RFCA 可成功消除 PVCs 并改善心功能。
