孙育民,刘旭,王骏,王新华,施海峰,吴卫华,陆静,周立,顾佳宁,董佳霖,方唯一

• 1:上海交通大学附属胸科医院心内科
• 2:上海市静安区中心医院心内科

摘要(Abstract)：

目的评价导管消融治疗持续性心房颤动(房颤)伴左室功能不全的安全性以及临床疗效。方法心力衰竭(心衰)组为30例持续性房颤伴症状性左室功能不全(左室射血分数≤0.45)患者,对照组为年龄、性别、左房大小和房颤持续时间相匹配的60例无心衰的持续性房颤患者,均接受环肺静脉电隔离联合心房碎裂电位消融治疗房颤。比较两组导管消融手术相关参数及严重并发症发生率。对心衰组术前、术后的左房大小、左室功能及内径进行比较。结果两组病例均完成导管消融术,肺静脉隔离率分别为96.67%及98.33%(P=1.00)。两组间消融时间、X线透视时间和严重并发症发生率差异无统计学意义(202.23±39.03 min比201.87±36.80 min,P=0.97;26.80±7.77 min比27.06±7.16 min,P=0.88;3.3%比3.4%,P=1.00)。随访11±1个月,73%的心衰组患者和78%对照组患者维持窦性心律(P=0.61),两组中分别有40%和42%患者接受再次消融。与术前相比,术后9个月心衰组患者的左室射血分数增加了7.87%±4.72%,左房内径缩小3.77±4.02 mm,左室舒张末期内径减小6.87±5.32 mm,左室收缩末期内径减小8.93±7.60 mm(P均<0.05);维持窦性心律者心功能改善程度高于未能维持窦性心律者。结论包括器质性心脏病者在内,对于持续性房颤合并左室功能不全的患者,环肺静脉电隔离联合心房碎裂电位消融的并发症发生率及消融成功率与无左室功能不全的患者相似。房颤合并左室功能不全的患者经导管消融治疗后,左房、室扩大程度减轻,左室射血分数可得到显著提高。

关键词(KeyWords)： 心房颤动;心力衰竭,充血性;导管消融术;肺静脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 孙育民,刘旭,王骏,王新华,施海峰,吴卫华,陆静,周立,顾佳宁,董佳霖,方唯一

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