心脏射频消融术治疗心房颤动对继发性三尖瓣反流影响的研究进展

Research Progress on the Effect of Radiofrequency Catheter Ablation in the Treatment of Atrial Fibrillation on Secondary Tricuspid Regurgitation

摘要: 心房颤动是临床最常见的心律失常类型，继发性三尖瓣反流作为其常见并发症，是心血管疾病领域中易被忽视且临床管理极具挑战性的问题，二者存在紧密的病理生理关联并形成恶性循环。心房颤动发作时心房丧失规律收缩功能，可诱发右心房重构和三尖瓣环扩张，进而引发房性继发性三尖瓣反流；而继发性三尖瓣反流会进一步增加心脏容量负荷，加剧心房重构，促进房颤的持续和发展。心脏射频消融术通过消除异常电信号传导路径，恢复窦性心律，可改善心肌的能量代谢和电生理特性，促进心肌的修复和心脏逆向重构，从而改善继发性三尖瓣反流程度。心脏射频消融术在改善心房颤动合并继发性三尖瓣反流患者的瓣膜反流、逆转右心重构方面发挥重要作用，为该类患者的临床诊疗提供了新的思路与有效干预手段。

Abstract: Atrial fibrillation (AF) is the most common type of arrhythmia in clinical practice. Secondary tricuspid regurgitation (STR), a common complication of AF, is an easily overlooked problem with great challenges in clinical management in the field of cardiovascular diseases. There is a close pathophysiological association between the two, forming a vicious cycle. During AF episodes, the atria lose their regular contractile function, which can induce right atrial remodeling and tricuspid annular dilatation, thereby triggering atrial secondary tricuspid regurgitation (A-STR). In turn, STR further increases cardiac volume load, exacerbates atrial remodeling, and promotes the persistence and progression of AF. Cardiac radiofrequency catheter ablation (RFCA) can improve myocardial energy metabolism and electrophysiological characteristics, promote myocardial repair and cardiac reverse remodeling by eliminating abnormal electrical signal conduction pathways and restoring sinus rhythm, thereby reducing the severity of STR. RFCA plays an important role in improving valvular regurgitation and reversing right ventricular remodeling in patients with AF complicated by STR, providing new ideas and effective intervention methods for the clinical diagnosis and treatment of such patients.