室间隔射频消融及心室起搏术治疗左室流出道动态梗阻的效果对比

Comparison of the efficacy of intramyocardial septal radiofrequency ablation and ventricular pacemaker in the treatment of dynamic left ventricular outflow tract obstruction

摘要:

目的 探讨室间隔射频消融及心室起搏术治疗左室流出道动态梗阻（LVOTO）的效果。方法 选取2017年6月—2023年1月成都大学附属医院心血管内科收治的90例LVOTO患者，按照随机数字表法分为观察组和对照组，每组45例。观察组采取室间隔射频消融治疗，对照组采取心室起搏术治疗，对比两组术后1年的疗效。结果 观察组手术前后左心室舒张末期内径、左心室射血分数、左心室质量指数、静息左心室流出道压差（LVOTPG）、负荷LVOTPG水平的差值均高于对照组（P <0.05）。观察组手术前后N末端B型钠尿肽前体（NT-proBNP）、肌钙蛋白Ⅰ（cTnⅠ）的差值均高于对照组（P <0.05）。两组室间隔中间段厚度、室间隔基底段厚度、左心室后壁厚度比较，差异均无统计学意义（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 LVOTO患者采取心室起搏术、室间隔射频消融术均能改善心功能和cTnI和NT-proBNP水平，且并发症发生率较低，值得临床推广。

Abstract:

Objective To investigate the efficacy of intramyocardial septal radiofrequency ablation and ventricular pacemaker in the treatment of dynamic left ventricular outflow tract obstruction (LVOTO).Methods The 90 patients with dynamic LVOTO admitted to the Department of Cardiology of the Affiliated Hospital of Chengdu University from June 2017 to January 2023 were selected, and were divided into the observation group and the control group according to random number table method, with 45 cases in each group. The observation group was treated with intramyocardial septal radiofrequency ablation and the control group was treated with ventricular packing. The therapeutic effects of the two groups were compared one year after surgery.Results The differences of left ventricular end-diastolic diameter, left ventricular mass index, left ventricular outflow tract pressure gradient (LVOTPG) and LVOTPG on provocation before and after the operation in the observation group were higher than those in the control group (P < 0.05). The differences of the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin Ⅰ (cTnⅠ) before and after the operation in the observation group were higher than those in the control group (P < 0.05). There was no significant difference between the observation group and the control group in the middle interventricular septal thickness, the basal interventricular septal thickness and the posterior wall thickness (P > 0.05). There was no significant difference in the overall incidence of complications between the observation group and the control group (P > 0.05).Conclusion For patients with dynamic LVOTO, both ventricular packing and intramyocardial septal radiofrequency ablation can improve cardiac function and levels of cTnI and NT-proBNP, with a low incidence of complications, making them worthy of being widely applied in clinical practice.