射频消融术对房室结折返性心动过速和房室折返性心动过速患者左房收缩功能的影响。
The effects of radiofrequency ablation on left atrial systolic function in patients with atrioventricular nodal reentrant and atrioventricular reentrant tachycardias.
机构信息
Department of Electrocardiology, Institute of Cardiology, Jagiellonian University, Collegium Medicum, The John Paul II Hospital, Krakow, Poland.
出版信息
Kardiol Pol. 2011;69(2):116-22.
BACKGROUND
Recurrent supraventricular arrhythmias may cause remodelling of the atria. The effects of radiofrequency (RF) ablation of these arrhythmias on left atrial function have not been well established.
AIM
To evaluate the effects of RF ablation on left atrial systolic function in patients with atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular tachycardia (AVRT).
METHODS
The study group consisted of 70 patients (22 men), in whom successful RF ablation of slow pathway (35 patients) or accessory pathway (35 patients) was performed. Patients with atrial fibrillation, structural heart disease, ventricular arrhythmias (> class 3 Lown), impaired left ventricular systolic function or on antiarrhythmics were excluded. All the patients had echocardiographic study before and 6 months after ablation. Left atrial systolic function was assessed using atrial ejection force (AEF) according to Manning's formula (AEF = 0.5 x ρ x MA x A(2), r: blood density = 1.06 g/cm(3), MA: mitral orifice area [cm(2)], A: A wave velocity). The following left atrial dimensions were assessed: antero-posterior (LA-AP), infero-superior (LA-IS, long axis), medio-lateral (LA-ML, short axis). The correlations between AEF and electrophysiological parameters were analysed (VA - ventriculo-atrial conduction, VA/CL - tachycardia cycle length).
RESULTS
The AEF increased significantly in the AVNRT group (7.78 vs 10.75 kdynes; p < 0.001) whereas it did not change in the AVRT group (8.96 vs 9.50, NS). Left atrial dimensions decreased significantly in both groups (AVNRT group: LA-AP: 38 vs 34 mm; LA-ML: 37 vs 33 mm; LA-IS: 51 vs 45 mm; p < 0.001; AVRT group: LA-AP: 38 vs 36 mm; p < 0.01; LA-ML: 37 vs 35 mm, p < 0.001; LA-IS: 50 vs 46 mm; p < 0.001). There was a significant correlation between the increment of AEF and electrophysiological parameters of the tachycardia (VA, r = -0.51 and VA/CL, r = -0.53).
CONCLUSIONS
- RF ablation of AVNRT is associated with the improvement of left atrial systolic function. 2. Left atrial size decreases following RF ablation of both AVNRT and AVRT. 3. The effects of RF ablation on the left atrial systolic function depends on electrophysiological parameters of the tachycardia (VA and VA/CL).
背景
复发性室上性心律失常可能导致心房重构。射频（RF）消融这些心律失常对左心房功能的影响尚未得到很好的证实。
目的
评估 RF 消融对房室结折返性心动过速（AVNRT）和房室折返性心动过速（AVRT）患者左心房收缩功能的影响。
方法
研究组包括 70 例患者（22 例男性），成功进行了慢径（35 例）或旁路（35 例）的 RF 消融。排除心房颤动、结构性心脏病、室性心律失常（> 3 级 Lown）、左心室收缩功能障碍或正在服用抗心律失常药物的患者。所有患者在消融前和消融后 6 个月均进行了超声心动图检查。采用 Manning 公式（AEF = 0.5 x ρ x MA x A(2)，r：血液密度 = 1.06 g/cm(3)，MA：二尖瓣口面积[cm(2)]，A：A 波速度）评估左心房收缩功能。评估以下左心房参数：前后径（LA-AP）、下上径（LA-IS，长轴）、中侧径（LA-ML，短轴）。分析 AEF 与电生理参数之间的相关性（VA-房室传导，VA/CL-心动过速周期长度）。
结果
AVNRT 组的 AEF 显著增加（7.78 对 10.75 kdynes；p < 0.001），而 AVRT 组无变化（8.96 对 9.50，NS）。两组的左心房大小均显著减小（AVNRT 组：LA-AP：38 对 34 mm；LA-ML：37 对 33 mm；LA-IS：51 对 45 mm；p < 0.001；AVRT 组：LA-AP：38 对 36 mm；p < 0.01；LA-ML：37 对 35 mm，p < 0.001；LA-IS：50 对 46 mm；p < 0.001）。AEF 的增加与心动过速的电生理参数（VA，r = -0.51 和 VA/CL，r = -0.53）显著相关。
结论
- AVNRT 的 RF 消融与左心房收缩功能的改善相关。2. RF 消融后 AVNRT 和 AVRT 患者的左心房大小均减小。3. RF 消融对左心房收缩功能的影响取决于心动过速的电生理参数（VA 和 VA/CL）。
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