知识与财富的链接
目的观察环肺静脉消融电隔离术治疗阵发性心房颤动(简称房颤),术中出现去迷走效应及消融碎裂电位对疗效的影响。方法对89例阵发性房颤患者行环肺静脉射频消融术治疗,消融终点为肺静脉电隔离,将术中出现去迷走效应及标测到碎裂电位并进行消融的房颤患者列为阳性组,余患者列为阴性组。观察比较两组患者术前、术后1天、3个月、6个月的心率变异性(HRV)指标、左房内径(LAD)、左室射血分数(EF)的变化。结果 89例均达消融终点,术后3个月保持窦性心律且无房性心律失常发作的患者64例,其中阳性组23例,阴性组41例。阳性组成功率高于阴性组(85.19%vs66.13%,P<0.05)。术后6个月阳性组HRV较术前降低(P<0.05),阴性组无明显变化(P>0.05)。与术前比较两组术后6个月的LAD减小、EF增加(P<0.05),阳性组LAD减小值高于阴性组(P<0.05),而EF增加值无差异(P>0.05)。结论环肺静脉消融术治疗房颤过程中发生去迷走效应及碎裂电位消融可伴有房颤消融成功率的增加,左房内径减小,不降低患者的EF值。
Objective To observe the effect of vagal denervation （VD） and ablation of fragmented potential on treatment in paroxysmal atrial fibrillation （PAF） during the operation of circumferential pulmonary vein ablation （CPVA）. Methods Eighty-nine cases were accepted the treatment of CPVA, the ablation endpoint was electrical isolation of pulmonary veins. The cases occured VD and ablation of the fragmented potential mapped in the operation were regarded as the positive group, the others as a negative group. The date of two groups including heart rate variability （HRV） , left atrial diameter （LAD） and left ventricular ejection fraction （LVEF） were observed and compared during the preoperative time, postoperative time of 1 st day,3rd month and 6th month. Results All of the eighty-nine cases achieved the endpoint. 64 cases maintained sinus rhythm after 3 months without atrial arrhythmias including 23 cases of positive group and 41 of negative group. The success ratio of positive group was higher than negative group（ 85.19% vs 66.13 % , P 〈 0.05 ）. HRV of positive group in postoperative of 6th month were all reduced compared the preoperative （P 〈 0. 05）, the changes of negative group were no significant differences （ P 〉 0. 05 ）. LVEF of the two groups were all raised and the LAD reduced （ P 〈 0.05 ）. The reduced values of LAD were higher in positive group than that in negative group （P 〈 0.05）, and raised EF were of no significant difference （P 〉 0.05）. Conclusion With the occurrence of VD and ablation of fragmented potential during the operation of CPVA for the treatment of PAF patients, it may be accompanied by an increasing of success rate, decreased acromegalic LAD values notably, and not reduced EF values.