Robertson Jason O, Lee Anson M, Voeller Rochus K, Damiano Marci S, Schuessler Richard B, Damiano Ralph J
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA
Eur J Cardiothorac Surg. 2014 Oct;46(4):720-8. doi: 10.1093/ejcts/ezt656. Epub 2014 Feb 11.
The effect of atrial fibrillation (AF) on left atrial (LA) function has not been well defined and has been largely based on limited echocardiographic evaluation. This study examined the effect of AF and a subsequent Cox-Maze IV (CMIV) procedure on atrial function.
Cardiac magnetic resonance imaging (cMRI) was performed in 20 healthy volunteers, 8 patients with paroxysmal atrial fibrillation (PAF) and 7 patients with persistent or long-standing persistent atrial fibrillation (LSP AF). Six of the PAF patients underwent surgical ablation with the CMIV procedure and 5 underwent both pre- and postoperative cMRIs. The persistent or LSP AF patients underwent only postoperative cMRIs because all scans were performed with patients in normal sinus rhythm. Volume-time curves throughout the cardiac cycle and regional wall shortening were evaluated using the cine images and compared across groups.
Compared with normal volunteers, patients with PAF had significantly decreased reservoir contribution to left ventricular (LV) filling (P = 0.0010), an increased conduit function contribution (P = 0.04) and preserved booster pump function (P = 0.14). Following the CMIV procedure, significant reductions were noted with respect to reservoir and booster pump function, with corresponding increases in conduit function. These differences were more drastic in patients with persistent/LSP AF. Regional wall motion was significantly reduced by PAF in all wall segments (P < 0.05), but was not further reduced by the CMIV. Despite changes in LA function, LV function was preserved following surgery.
PAF significantly altered LA function and has a detrimental effect on regional wall motion. Surgical intervention further altered LA function, but the reasons for this are likely multifactorial and not entirely related to the lesion set itself.
心房颤动（AF）对左心房（LA）功能的影响尚未明确界定，且很大程度上基于有限的超声心动图评估。本研究探讨了AF及随后的Cox迷宫IV（CMIV）手术对心房功能的影响。
对20名健康志愿者、8名阵发性心房颤动（PAF）患者和7名持续性或长期持续性心房颤动（LSP AF）患者进行心脏磁共振成像（cMRI）检查。6名PAF患者接受了CMIV手术消融，5名患者在术前和术后均接受了cMRI检查。持续性或LSP AF患者仅在术后接受cMRI检查，因为所有扫描均在患者处于正常窦性心律时进行。使用电影图像评估整个心动周期的容积-时间曲线和局部室壁缩短情况，并在各组之间进行比较。
与正常志愿者相比，PAF患者左心室（LV）充盈的储存功能贡献显著降低（P = 0.0010），管道功能贡献增加（P = 0.04），增强泵功能保留（P = 0.14）。CMIV手术后，储存和增强泵功能显著降低，管道功能相应增加。这些差异在持续性/LSP AF患者中更为明显。PAF使所有壁段的局部壁运动显著降低（P < 0.05），但CMIV手术并未使其进一步降低。尽管LA功能发生了变化，但手术后LV功能得以保留。
PAF显著改变了LA功能，并对局部壁运动产生有害影响。手术干预进一步改变了LA功能，但其原因可能是多因素的，并不完全与病变本身相关。
