射频消融术治疗心动过速性心肌病的临床研究
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摘要
目的探讨导管射频消融术(RFCA)治疗心动过速性心肌病(TIC)的安全性及临床疗效。方法选取经心电图和超声心动图证实快速心律失常、左心房和(或)左心室增大,心功能减低(EF<50%)的单纯性心动过速性心肌病患者20例,经RFCA治疗后随访6个月,观察术前,术后后3、6个月的心率和窦性心律维持情况、抗心律失常和抗心衰药物使用率、心胸比率(CTR)、左心室射血分数(LVEF)、左心房前后径(LAD)、左心室舒张末期内径(LVEDD)、血浆N末端脑钠肽前体(NT-proBNP)水平以及6 min步行距离(6-MWT)改善情况。结果 1例右心耳房速患者射频消融手术失败,1例持续性房颤患者术后3个月复发,长期口服药物治疗,心室率控制在70～90次/min,18例患者术后转复为窦性心律,手术成功率90%。术后1例患者出现股动脉血肿经压迫后好转,所有患者术中、术后无心包填塞、冠状动脉损伤等严重并发症。射频消融术后3个月与术前比较Ⅰ级心功能比例增多,心率、抗心律失常和抗心衰药物应用率均下降,CRT、LAD、LVEDD缩小、NT-proBNP下降、LVEF及6-MWT提高,2组比较差异均有统计学意义(P<0.05);术后6个月与术后3个月比较Ⅰ级心功能比例进一步增多,抗心律失常和抗心衰药物应用率进一步下降,CRT、LAD、LVEDD进一步缩小、6-MWT进一步下降、LVEF及进一步提高,差异均有统计学意义(P<0.05)。结论射频消融术治疗心动过速性心肌病安全有效,值得临床推广。
Objective To investigate the safety and clinical efficacy of radiofrequency catheter ablation(RFCA) in treatment of tachycardia-induced cardiomyopathy(TIC).Methods A total of 20 patients with TIC,with the left atrium and/or the left ventricle enlargement and cardiac dysfunction(LVEF<50%) who were diagnosed by electrocardiogram and echocardiography were enrolled in the study.The patients were follwed up for 6 months after RFCA,then the heart rate and sinus rhythm maintenance status,anti-arrhythmia and anti-heart failure drug utilization rate,cardiothoracic ratio(CTR),left ventricular ejection fraction(LVEF),anteroposterior diameter of left atrium(LAD),left ventricular end-diastolic diameter(LVEDD),the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP) and 6-minute walking test improvement status(6-MWT) were compared before and at 3 m,6 m after treatment.Results RFCA failed in 1 patient with right atrial tachycardia,and 1 patient with persistent atrial fibrillation had recurrence at 3 months after operation,with long-term oral drug therapy,and patient's heart rate was controlled at 70 ～ 90 bpm.And 18 patients were returned to sinus rhythm after operation,with operation success rate being 90%.Moreover 1 patient had femoral artery hematoma after operation.There were no pericardial tamponade,coronary artery injury and other serious complications in all the patients.After RFCA,the proportion of NYHA ClassⅠwas increased,the heart rate and the drug use rate of anti-arrhythmia and anti-heart failure were decreased.The CRT,LAD,LVEDD,NT-proBNP were decreased,however,LVEF and 6-MWT were increased at 3 months after operation.Furthermore,the proportion of NYHA ClassⅠwas increased further at 6 months after operation,and the drug use rates of antiarrhythmia and anti-heart failure were decreased further,moreover,the CTR,LAD,LVEDD and NT-proBNP were decreased further,however,the levels of LVEF and 6-MWT were increased significantly(P<0.05).Conclusion RFCA is safe and effective in treatment of TIC,therefor,it is worthy of promotion in clinical practice.
Objective To investigate the safety and clinical efficacy of radiofrequency catheter ablation(RFCA) in treatment of tachycardia-induced cardiomyopathy(TIC).Methods A total of 20 patients with TIC,with the left atrium and/or the left ventricle enlargement and cardiac dysfunction(LVEF<50%) who were diagnosed by electrocardiogram and echocardiography were enrolled in the study.The patients were follwed up for 6 months after RFCA,then the heart rate and sinus rhythm maintenance status,anti-arrhythmia and anti-heart failure drug utilization rate,cardiothoracic ratio(CTR),left ventricular ejection fraction(LVEF),anteroposterior diameter of left atrium(LAD),left ventricular end-diastolic diameter(LVEDD),the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP) and 6-minute walking test improvement status(6-MWT) were compared before and at 3 m,6 m after treatment.Results RFCA failed in 1 patient with right atrial tachycardia,and 1 patient with persistent atrial fibrillation had recurrence at 3 months after operation,with long-term oral drug therapy,and patient's heart rate was controlled at 70 ～ 90 bpm.And 18 patients were returned to sinus rhythm after operation,with operation success rate being 90%.Moreover 1 patient had femoral artery hematoma after operation.There were no pericardial tamponade,coronary artery injury and other serious complications in all the patients.After RFCA,the proportion of NYHA ClassⅠwas increased,the heart rate and the drug use rate of anti-arrhythmia and anti-heart failure were decreased.The CRT,LAD,LVEDD,NT-proBNP were decreased,however,LVEF and 6-MWT were increased at 3 months after operation.Furthermore,the proportion of NYHA ClassⅠwas increased further at 6 months after operation,and the drug use rates of antiarrhythmia and anti-heart failure were decreased further,moreover,the CTR,LAD,LVEDD and NT-proBNP were decreased further,however,the levels of LVEF and 6-MWT were increased significantly(P<0.05).Conclusion RFCA is safe and effective in treatment of TIC,therefor,it is worthy of promotion in clinical practice.
引文
1 Povoly J.Tachycardia-induced cardiomyopathy.Vnitr Lek,2015,61:56-59.
2 Chin A,Badri M,Ntusi NB,et al.The clinical,electrocardiographic and echocardiographic characteristics and long-term outcome of patients with tachycardia-induced cardiomyopathy.Cardiovasc J Afr,2012,23:136-142.
3 Guyatt GH,Sullivan MT,Thompson PJ,et al.The 6-minute walk:A new measurement of exercise capacity in patients with chronic heart failure.Can Med Assoc J,1985,132:919-923.
4 Gossage AM,Braxton Hicks JA.On auricular fibrillation.QJM,1913,6:435-440.
5 Elliott P,Andersson B,Arbustini E,et al.Classification of the cardiomyopathies:a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J,2008,29:270-276.
6 Fenelon G,Wijins W,Andries E,et al.Tachycardiomyopathy:mechanisms and cliaical implications.Pacing Clin Electrophysiol,1996,19:95-106.
7 Salimian S,Thibault B,Finnerty V,et al.Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model.J Nucl Cardiol,2017,24:145-157.
8 Elliott P.Defining tachycardia-induced cardiomyopathy:life in the fast lane.J Am Coll Cardiol,2017,69:2173-2174.
9 Patel H,Madanieh R,Kosmas CE,et al.Reversible cardiomyopathies.Clin Med Insights Cardiol,2015,9:7-14.
10李学斌.心律失常性心肌病.中国实用内科杂志,2012,32:498-501.
11 Lau DH,Thiyagarajah A,Willems S,et al.Device therapy for rate control:Pacing resynchronisation and AV node ablation.Heart Lung Circ,2017,26:934-940.
12 Di Biase L,Mohanty P,Mohanty S,et al.Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device:results from the AATAC multicenter randomized trail.Circulation,2016,133:1637-1644.
13 Marrouche NF,Brachmann B,Nassir F,et al.Catheter ablation for atrial fibrillation with heart failure.N Engl J Med,2018,378:417-427.
14黄从新,张澍,黄德嘉,等.心房颤动;目前的认识和治疗建议-2018.中国心脏起搏与心电生理杂志,2018,32:315-368.
15郭继鸿.再论房颤性心肌病.临床心电学杂志,2016,25:375-386.
16 Ju W,Yang B,Li M,et al.Tachycardiomyopathy complicated by focal atrial tachycardia:incidence,risk factors,and long-term outcome.JCardiovasc Electrophysiol,2014,25:953-957.
17 Pereira Nunes Mdo C,Barbosa MM,Ribeiro AL,et al.Predictors of mortality in patients with dilated cardiomyopathy:relevance of chagas disease as an etiological factor.Rev Esp Cardiol,2010,63:788-797.
18 Freixa X,Berruezo A,Mont L,et al.Characterization of focal right atrial appendage tachycardia.Europace,2008,10:105-109.
19 Chugh SS,Shen WK,Luria DM,et al.First evidence of premature ventricular complex-induced cardiomyopath:a potentially reversible cause of heart failure.Cardiovasc Electrophysiol,2000,11:328-329.
20 Hasdemir C,Ulucan C,Yavuzgil O,et al.Tachycardia-induced cardiomyopathy in patients with idiopathic Ventricular arrthythmias:the incidence,clinical and electrophysioiogic charactensties,and the predictors.J Cardiovasc Electrophysiol,2011,22:663-668.
21丁燕生,马坚,马长生,等.射频导管消融治疗快速心律失常指南(修订版).中国心脏起搏与心电生理杂志,2002,16:6-20.
2 Chin A,Badri M,Ntusi NB,et al.The clinical,electrocardiographic and echocardiographic characteristics and long-term outcome of patients with tachycardia-induced cardiomyopathy.Cardiovasc J Afr,2012,23:136-142.
3 Guyatt GH,Sullivan MT,Thompson PJ,et al.The 6-minute walk:A new measurement of exercise capacity in patients with chronic heart failure.Can Med Assoc J,1985,132:919-923.
4 Gossage AM,Braxton Hicks JA.On auricular fibrillation.QJM,1913,6:435-440.
5 Elliott P,Andersson B,Arbustini E,et al.Classification of the cardiomyopathies:a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J,2008,29:270-276.
6 Fenelon G,Wijins W,Andries E,et al.Tachycardiomyopathy:mechanisms and cliaical implications.Pacing Clin Electrophysiol,1996,19:95-106.
7 Salimian S,Thibault B,Finnerty V,et al.Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model.J Nucl Cardiol,2017,24:145-157.
8 Elliott P.Defining tachycardia-induced cardiomyopathy:life in the fast lane.J Am Coll Cardiol,2017,69:2173-2174.
9 Patel H,Madanieh R,Kosmas CE,et al.Reversible cardiomyopathies.Clin Med Insights Cardiol,2015,9:7-14.
10李学斌.心律失常性心肌病.中国实用内科杂志,2012,32:498-501.
11 Lau DH,Thiyagarajah A,Willems S,et al.Device therapy for rate control:Pacing resynchronisation and AV node ablation.Heart Lung Circ,2017,26:934-940.
12 Di Biase L,Mohanty P,Mohanty S,et al.Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device:results from the AATAC multicenter randomized trail.Circulation,2016,133:1637-1644.
13 Marrouche NF,Brachmann B,Nassir F,et al.Catheter ablation for atrial fibrillation with heart failure.N Engl J Med,2018,378:417-427.
14黄从新,张澍,黄德嘉,等.心房颤动;目前的认识和治疗建议-2018.中国心脏起搏与心电生理杂志,2018,32:315-368.
15郭继鸿.再论房颤性心肌病.临床心电学杂志,2016,25:375-386.
16 Ju W,Yang B,Li M,et al.Tachycardiomyopathy complicated by focal atrial tachycardia:incidence,risk factors,and long-term outcome.JCardiovasc Electrophysiol,2014,25:953-957.
17 Pereira Nunes Mdo C,Barbosa MM,Ribeiro AL,et al.Predictors of mortality in patients with dilated cardiomyopathy:relevance of chagas disease as an etiological factor.Rev Esp Cardiol,2010,63:788-797.
18 Freixa X,Berruezo A,Mont L,et al.Characterization of focal right atrial appendage tachycardia.Europace,2008,10:105-109.
19 Chugh SS,Shen WK,Luria DM,et al.First evidence of premature ventricular complex-induced cardiomyopath:a potentially reversible cause of heart failure.Cardiovasc Electrophysiol,2000,11:328-329.
20 Hasdemir C,Ulucan C,Yavuzgil O,et al.Tachycardia-induced cardiomyopathy in patients with idiopathic Ventricular arrthythmias:the incidence,clinical and electrophysioiogic charactensties,and the predictors.J Cardiovasc Electrophysiol,2011,22:663-668.
21丁燕生,马坚,马长生,等.射频导管消融治疗快速心律失常指南(修订版).中国心脏起搏与心电生理杂志,2002,16:6-20.
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