Objective: Exploring the effect of radiofrequency ablation treatment to restore sinus rhythm on the improvement of functional mitral regurgitation (FMR) and cardiac structure in patients with atrial fibrillation combined with moderate or severe FMR, compared with drug therapy alone. Methods: This retrospective cohort study consecutively enrolled patients diagnosed with persistent atrial fibrillation and moderate or severe FMR who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2021. Forty-eight patients who were treated with radiofrequency ablation and maintained sinus rhythm were enrolled in the ablation group, and 63 patients who were treated with medication alone during the same period were in the medicine group. Patients in the ablation group and medicine group were matched in a 1∶1 ratio using a propensity score, and 41 patients were finally included in each of the 2 groups. All patients reexamined echocardiography after 3-month of treatment. The proportion of patients with FMR improvement and the differences in changes of cardiac structural and functional parameters were compared between groups. Results: After propensity score matching, the ablation group was aged (69.3±7.1) years with 21 males (51.2%) and the medicine group was aged (71.3±9.4) years with 21 males (51.2%). The echocardiography after 3-month of treatment showed the rate of FMR improvement was significantly higher in the ablation group than in the medicine group (19 (46.3%) vs. 33 (80.5%), P<0.001), and patients in the ablation group showed a significant decrease in FMR extent (Δmitral regurgitation area: (-1.30±2.64) cm2 vs. (-3.55±2.50) cm2, P<0.001), left atrial size (Δleft atrial diameter: (-0.17±3.78) mm vs. (-2.46±4.01) mm, P=0.009) and E/e' (ΔE/e':-2.54±7.34 vs.-6.34±7.08, P=0.021) compared with the medicine group. There was also a significant decrease in left ventricular size (Δleft ventricular end diastolic diameter: (-3.12±6.62) mm vs. (-0.73±3.62) mm, P=0.046) and significant increase in left ventricular ejection fraction (Δleft ventricular ejection fraction: (2.73±9.69) % vs. (-0.93±5.41) %, P=0.038) in ablation group. Conclusion: Performing radiofrequency ablation to restore sinus rhythm can effectively reduce the severity of mitral regurgitation and improve left atrial and left ventricular remodeling and cardiac function in patients with atrial fibrillation and FMR.
目的： 探讨在心房颤动（房颤）合并中度以上功能性二尖瓣反流的患者中，与单纯药物治疗相比，行射频消融术治疗恢复窦性心律对功能性二尖瓣反流和心脏结构与功能的改善效果。 方法： 本研究为回顾性队列研究，连续入选2019年1月至2021年12月于中山大学附属第三医院住院且诊断为持续性房颤合并中度以上功能性二尖瓣反流的患者。以行射频消融术治疗、术后维持窦性心律的48例患者为消融组，同期单纯予药物治疗的63例患者为药物组。采用倾向性匹配评分以1∶1的比例匹配消融组和药物组患者，最终2组各纳入41例患者。所有患者于治疗后3个月复查彩色超声心动图，比较2组患者功能性二尖瓣反流改善的比例，以及心脏结构与功能参数变化的差异。 结果： 倾向性评分匹配后，消融组年龄（69.3±7.1）岁，男性21例（51.2%），药物组年龄（71.3±9.4）岁，男性21例（51.2%）。治疗后3个月复查彩色超声心动图显示，消融组患者的功能性二尖瓣反流改善率高于药物组［33例（80.5%）比19例（46.3%），P<0.001］；与药物组相比，消融组功能性二尖瓣反流程度［二尖瓣反流面积变化值：（-3.55±2.50）cm2比（-1.30±2.64）cm2，P<0.001］、左心房内径［变化值：（-2.46±4.01）mm比（-0.17±3.78）mm，P=0.009］、室间隔舒张早期二尖瓣血流速度与二尖瓣环运动速度比值（E/e′）［变化值：（-6.34±7.08）比（-2.54±7.34），P=0.021］、左心室舒张末期内径［变化值：（-3.12±6.62）mm比（-0.73±3.62）mm，P=0.046］下降更明显，左心室射血分数［变化值：（2.73±9.69）%比（-0.93±5.41）%，P=0.038］升高更明显。 结论： 行射频消融术恢复窦性心律可以有效改善房颤合并功能性二尖瓣反流患者的功能性二尖瓣反流程度以及左心房和左心室的重构，改善心功能。.