张学芳,高伟栋,任强,谭文锋,赖玉庭,刘金学,张斌,张高星

• 1:江门市中心医院心内科

摘要(Abstract)：

目的 探讨导管消融治疗持续性心房颤动（房颤）伴心力衰竭合并慢性肾功能不全患者的疗效。方法 连续入选2016年1月至2020年6月在江门市中心医院心内科住院的持续性房颤伴左心室射血分数（LVEF）<50%合并慢性肾功能不全的患者49例。所有患者均行导管消融治疗，评估、测量患者术前、术后半年、术后1年纽约心脏病协会（NYHA）心功能分级、6 min步行试验距离、左心室舒张末期内径（LVEDd）、LVEF、左心房内径、内生肌酐清除率（Ccr）和脑钠肽（BNP）水平。结果 术后半年、术后1年与术前相比，患者NYHA心功能分级改善，6 min步行试验距离增加[（533±106）m比（569±124）m比（467±112）m,P<0.05],LVEDd缩小[（52.8±5.2）mm比（51.3±6.1）mm比（56.3±8.1）mm,P<0.05],LVEF增大[（42.1±7.5）%比（47.3±8.6）%比（39.5±6.3）%,P <0.05]，左心房内径缩小[（43.3±5.1）mm比（40.8±5.6）mm比（45.3±5.9）mm,P<0.05]，血浆BNP浓度明显下降[8786(2695,10817)pg/ml比5643(3144,7682)pg/ml比11098(7725,12117)pg/ml,P <0.05],Ccr较前明显升高[（85.7±10.4）ml/（min·1.73m~2）比（101.1±10.5）/ml(min·1.73m~2)比（64.8±9.8）ml/（min·1.73 m~2）,P<0.05]。结论 导管消融治疗能改善持续性房颤伴心力衰竭合并慢性肾功能不全患者的心肾功能。

关键词(KeyWords)： 导管消融;持续性心房颤动;心力衰竭;慢性肾功能不全

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张学芳,高伟栋,任强,谭文锋,赖玉庭,刘金学,张斌,张高星

参考文献(References)：

• [1] Skanes AC,Tang ASL. Atrial fibrillation and heart failure:untangling a modern Gordian knot[J]. Can J Cardiol, 2018,34(11):1437-1448.
• [2] Richter S, Di Biase L, Hindricks G. Atrial fi brillation ablation in heart failure[J]. Eur Heart J, 2019,40(8):663-671.
• [3] Santhanakrishnan R, Wang N, Larson MG, et al.Atrial fi brillation begets heart failure and vice versa:temporal associations and dif ferences in preserved versus reduced ejection fraction[J]. Circulation,2016,133(5):484-492.
• [4] Nitta G, Inaba O, Kato S, et al. Catheter ablation for atrial fibrillation in patients with congestive heart failure[J]. Int J Cardilo,2021,333:98-104.
• [5] Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantifi cation by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J]. J Am Soc Echocardiogr,2015,28(1):1-39.
• [6]黄从新，张澍，黄德嘉，等.心房颤动：目前的认识和治疗建议（2018）[J].中华心律失常学杂志，2018,22(4):279-346.
• [7] Jenkins R,Mandarano L,Gu gathas S,et al. Impaired renal function affects clinical outcomes and management of patients with heart failure[J]. ESC Heart Fail,2017,4(4):576-584.
• [8] Argan O, Ural D, Kozdag G, et al. Associations between neutrophil gelatinase associated lipocalin, neutrophil-to-lymphocyte ratio, atrial fi brillation and renal dysfunction in chronic heart failure[J]. Med Sci Monit,2016,22:4765-4772.
• [9] Genovesi S, Pogliani D, Faini A, et al. Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients[J]. Am J Kidney Dis,2005,46(5):897-902.
• [10] Richards AM. N-terminal B-type natriuretic peptide in heart failure[J]. Heart Fail Clin,2018,14(1):27-39.
• [11] Tsai CT, Lai LP, Lin JL,et al. Renin-angiotensin system gene polymorphisms and atrial fi brillation[J]. Circulation,2004,109(13):1640-1646.
• [12] Gourraud JB, Andrade JG, Macle L, et al. Pharmacological tests in atrial fi brillation ablation[J]. Arrhythm Electrophysiol Rev,2016,5(3):170-176.
• [13]宋卫锋，陈珂，马继芳，等.导管射频消融在持续性心房颤动合并射血分数值降低的心力衰竭患者中的应用[J].中国心脏起搏与心电生理杂志，2021,35(1):33-36.
• [14]杨德彦，高鹏，方全.心房颤动合并心力衰竭患者的导管消融[J].中国介入心脏病学杂志，2018,26(12):705-708.
• [15] Kuwahara K. The natriuretic peptide system in heart failure:diagnostic and therapeutic implications[J]. Pharmacol Ther,2021,227:107863.
• [16] Yangisawa S, Inden Y, Kato H, et al. Impaired renal function is associated with recurrence after cryoballoon catheter ablation for paroxysmal atrial fi brillation:a potential ef fect of non-pulmonary vein foci[J]. J Cardiol, 2017,69(1):3-10.
• [17]王光记，孔彬，刘育，等.慢性肾功能不全与心房颤动患者导管消融术后复发的关系[J].山东医药，2018,58(17):16-19.