Luchsinger J A, Steinberg J S
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
J Am Coll Cardiol. 1998 Jul;32(1):205-10. doi: 10.1016/s0735-1097(98)00183-1.
We sought to serially assess left ventricular (LV) function before and after catheter ablation of atrial flutter (AFI).
The relation of tachycardia-induced cardiomyopathy to AFI and its response to direct catheter ablation are unknown.
LV function was assessed in a series of 59 consecutive patients with successful radiofrequency ablation (RFA) of AFI before and after the procedure. Eleven patients had dilated cardiomyopathy (LV ejection fraction [LVEF] <50%) and congestive heart failure (CHF) symptoms and are the subject of this report. LV function was assessed by LVEF on two-dimensional echocardiography and functional status by New York Heart Association (NYHA) CHF classification.
Patients were 59 +/- 8 years old, and were all male. Five patients had a preablation diagnosis of idiopathic cardiomyopathy. The preablation LVEF was 30.9 +/- 11.0% and improved to 41.3 +/- 16% (p = 0.005) when measured 7 months after successful ablation. NYHA CHF class improved from 2.6 +/- 0.5 to 1.6 +/- 0.9 (p = 0.002). Six (55%) of 11 patients had normalization of the LVEF, with complete resolution of CHF symptoms. A lower preablation LVEF and functional class predicted nonresolution of dilated cardiomyopathy (p = 0.002 and 0.001, respectively).
Restoration of normal sinus rhythm by RFA in patients with chronic AFI and cardiomyopathy substantially improved LV function. Resolution of dilated cardiomyopathy occurred in the majority of patients. Tachycardia-induced cardiomyopathy may be a more common mechanism of LV dysfunction in patients with AFI than expected, and aggressive treatment of this arrhythmia should be considered.
我们试图对心房扑动（AFI）导管消融术前和术后的左心室（LV）功能进行连续评估。
心动过速性心肌病与AFI的关系及其对直接导管消融的反应尚不清楚。
对一系列59例成功进行AFI射频消融（RFA）的患者在手术前后评估LV功能。11例患者患有扩张型心肌病（左心室射血分数[LVEF]<50%）并有充血性心力衰竭（CHF）症状，为本报告的研究对象。通过二维超声心动图评估LV功能，通过纽约心脏协会（NYHA）CHF分级评估功能状态。
患者年龄为59±8岁，均为男性。5例患者在消融术前被诊断为特发性心肌病。消融术前LVEF为30.9±11.0%，成功消融7个月后测量时提高到41.3±16%（p=0.005）。NYHA CHF分级从2.6±0.5改善到1.6±0.9（p=0.002）。11例患者中有6例（55%）LVEF恢复正常，CHF症状完全缓解。较低的消融术前LVEF和功能分级预示扩张型心肌病无法缓解（分别为p=0.002和0.001）。
慢性AFI和心肌病患者通过RFA恢复正常窦性心律可显著改善LV功能。大多数患者的扩张型心肌病得到缓解。心动过速性心肌病可能是AFI患者LV功能障碍比预期更常见的机制，应考虑积极治疗这种心律失常。
