The Effect Of The Circumferential Pulmonary Vein Radiofrequency Ablation Of Atrial Fibrillation On The Left Atrial Structure And Function

Objective To evaluate the effects of the circumferential pulmonary vein radio frequency ablation guided by Carto mapping system for atrial fibrillation(AF)on left atrial struncture and function by Ultrasonic cardiography(UCG).Methods 89 patients who received circumferential pulmonary vein ablation(CPVA) guided by Carto mapping system for AF in the second hospital of Tianjin Medical University from 2006 to 2008 were included in our study.Select 44 patients who got satisfactory ECG picture 1-3 days before operation and 3 months-half a year after operation to be study objects.31cases were male.The patients' age were between40-75,the average age was(60.57±6.96).All the patients in our study eliminated serious valvular disease of the heart,hyperthyreosis,atrial septal defect,the diseases of liver and kidney,heart functionⅢ-Ⅳ(NYHA)and other situations.The process of Electrophysiologic study and CPVA:Puncture right internal jugular vein or subclavian vein,and right femoral vein.Put coronary sinus rheophore and the two SWARTZ sheathing catheter(st,Jude Medical)into left atrium.Through SWARTZ sheathing catheter,put the crico-mapping catheter(lasso^TM,Bioserse-webstex) and the catheter used specially by Navx(Navi-star Thermo-cool,Bioserse-webstex) into pulmonary vein and left atrium,map pulmonary vein and do CPVA.Take antiarrhythmic drug orally after ablation.After drug withdrawal,observe the effect of ablation.Take Warfarin to maintain INR between 1.8-2.5.All the patients accept ECG before and after ablation.Observation index:(1)LAD(2)LAESV(3)LAEDV(4)the evacuation volume of left atrium(5)the passageway volume of left atrium(6)the peak value of mitral valve bloodstream speed(VA)(7)LAEF.Results(1)The comparison of the left atrial structure and function before and after CPVA for AF:the LAD,the LAEDV and the evacuation volume of left atrium after CPVA decreased compared with those before CPVA,the difference had statistical significance(P＜0.05);the LAESV and the passageway volune of the left atrium after CPVA decreased compared with those before CPVA,the difference had statistical significance(P＜0.01);the difference of the VA and the fraction of left atrium between before CPVA and after CPVA had no statistical significance(P＞0.05).(2)The comparison of the left atrial structure before and after CPVA for AF in palindromia group:the difference of the LAD,the LAESV and the LAEDV between before CPVA and after CPVA in palindromia group had no statistical significance(P＞0.05).(3)The comparison of the left atrial structure before and after CPVA for AF in no palindromia group:the LAD and the LAESV after CPVA decreased compared with those before CPVA in no palindromia group,the difference had statistical significance(P＜0.01);the difference of LAEDV between before CPVA and after CPVA had no statistical significance(P＞0.05) in no palindromia group.(4)The comparison of the left atrial structure after CPVA for AF in palindromia group and in no palindromia group:the left atrial inner diameter after CPVA in palindromia group was longer than that in no palindromia group,the difference had statistical significance(P＜0.05);the difference of LAESV and the LAEDV between palindromia group and no palindromia group after CPVA had no statistical significance(P＞0.05).(5)The comparison of the left atrial structure before CPVA for AF in palindromia group and in no palindromia group:the difference of the LAD,LAESV and the LAEDV between palindromia group and no palindromia group before CPVA had no statistical significance(P＞0.05).Conclusion(1)After CPVA guided by Carto mapping system for AF,the structure and function of left atrium occurred reconstitution.After CPVA guided by Carto mapping system for AF,the inner diameter and volume of left atrium were smaller than that before CPVA.The increase of left atrial inner diameter can be considered to be the morning recrudescent anticipation factor after CPVA guided by Carto mapping system for AF.(2)After CPVA guided by Carto mapping system for AF,the mechanical function of left atrium changed.The storing function of left atrium decreased,while there was no obvious change in the pumping function of left atrium.The changes of left atrial storing and pumping function made left atrial passageway function enhance.