射频消融联合左心耳封堵术对房颤患者左心结构及功能的影响

The Effect of Radiofrequency Ablation Combined with Left Atrial Appendage Occlusion on Left Heart Structure and Function in Patients with Atrial Fibrillation

摘要: 目的：分析射频消融联合左心耳封堵术对房颤患者左心功能及结构的影响，为一站式的临床应用提供更客观的依据。方法：连续纳入2022年3月至2023年4月期间在青岛大学附属医院心血管内科病房住院行一站式手术(LAAO + CA)的心房颤动患者50人，另取单纯行射频消融术(CA)患者50人为对照组，收集两组患者的临床资料，左心结构及功能指标，术后随访6个月，探索一站式手术患者对左心功能及结构的影响。结果：1) CA组与CA + LAAC组年龄、性别、体重指数(BMI)均无统计学差异(P > 0.05)，HAS-BLED、CHA2DS2-VASc评分有统计学差异(P值<0.05)。2) 术前到术后6个月的随访中，两组术后左心室舒张末期容积直径(LVDd)、左心室射血分数(LVEF)的差异无统计学差异(P > 0.05)，在左心房内径(LAD)、左心室舒张末期容积(LVDs)、二尖瓣环组织多普勒速度(e')、二尖瓣舒张末期速度E和二尖瓣环速度比值(E/e')方面的差异具有统计学意义(P < 0.05)，CA组的LAD、LVDs、E/e'小于CA + LAAC组，而CA组e'大于CA + LAAC组。3) CA组与CA + LAAC组患者自身前后比较中，CA组与CA + LAAC组患者LAD、LVEF自身前后对比差异均有统计学意义(P < 0.05)；CA组e'、E/e'自身前后对比差异具有统计学意义(P < 0.05)，而CA + LAAC组患者e'、E/e'无统计学意义(P > 0.05)。结论：1) 单纯射频消融术后患者，LAD较前缩小，LVEF上升，LVFP减小，可逆转心脏结构重构，改善心功能，与一站式手术相比，LAD缩小程度不如单纯射频消融术，左心收缩功能未受影响，提示左心耳封堵术可能减低射频消融术对左房重构的改善程度。2) 一站式手术e'减小，差异具有统计学意义，E/e'增加，差异具有统计学意义，说明左心耳封堵器内皮化后可能会引起舒张早期流入左心室的血量减少，左心室充盈压升高。

Abstract: To analyze the impact of radiofrequency ablation combined with left atrial appendage occlusion on left heart function and structure in patients with atrial fibrillation, and provide more objective basis for one-stop clinical application. Method: A total of 50 patients with atrial fibrillation who underwent one-stop surgery (LAAO + CA) in the Cardiovascular Department of Qingdao University Affiliated Hospital between March 2022 and April 2023 were enrolled consecutively. Another 50 patients who underwent simple radiofrequency ablation (CA) were selected as the control group. Clinical data, left heart structure and functional indicators were collected from both groups of pa-tients, and postoperative follow-up was conducted for 6 months to explore the impact of one-stop surgery on left heart function and structure. Result: 1) There was no statistically significant differ-ence in age, gender, and body mass index (BMI) between the CA group and the CA + LAAC group (P > 0.05). However, there was a statistically significant difference in HAS-BLED and CHA2DS2-VASc scores (P < 0.05). 2) During the preoperative to postoperative 6-month follow-up, there was no statistically significant difference (P > 0.05) between the two groups in left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF). However, there were statistically significant differences (P < 0.05) in left atrial diameter (LAD), left ventricular end diastolic volume (LVDs), mitral annular tissue Doppler velocity (e'), mitral end diastolic velocity E, and mitral annular velocity ratio (E/e') between the CA group and the CA group LVDs and E/e' are smaller than those in the CA + LAAC group, while the CA group e' is larger than that in the CA + LAAC group. 3) In the comparison between the CA group and the CA + LAAC group, there were statistically significant differences in LAD and LVEF between the CA group and the CA + LAAC group (P < 0.05); The difference between the CA group e' and E/e' before and after comparison was statistically significant (P < 0.05), while the CA + LAAC group had no statistically significant differences in e' and E/e' (P > 0.05). Conclusion: 1) In patients undergoing simple radiofrequency ablation, LAD decreases compared to before, LVEF increases, and LVFP decreases, which can reverse cardiac structural remodeling and improve cardiac function. Compared with one-stop surgery, the degree of LAD reduction is not as good as that of simple radiofrequency ablation, and left ventricular systolic function is not affected. This suggests that left atrial appendage occlusion may reduce the degree of improvement of radiofrequency ablation on left atrial remodeling. 2) The one-stop surgery showed a statistically significant decrease in E' and an increase in E/e', indicating that endothelialization of the left atrial appendage occluder may lead to a decrease in blood flow into the left ventricle during early diastole and an increase in left ventricular filling pressure.