直视下射频消融肺静脉口治疗风湿性心脏病心房颤动的临床观察  

The clinical study of circumferential ablation around orifice of pulmonary vein by radiofrequency energy with chronic atrial fibrillation undergoing rheumatic valvular heart surgery

作　　者：柏本健[1] 钟志欢[2] 辛凌澎 王春贵 王均志[2] 杜日映[2] 

机构地区：[1]山东省青岛市海慈医疗集团思达国际心脏(中心)医院心外科 [2]山东省青岛市海慈医疗集团海慈医院心内科

出　　处：《中华外科杂志》2006年第14期946-948,共3页Chinese Journal of Surgery

基　　金：山东省自然科学基金(Y2002C18)

摘　　要：目的探讨心脏直视下射频消融肺静脉口治疗风湿性心脏病心房颤动(房颤)的临床疗效。方法对20例风湿性心瓣膜病伴房颤患者(治疗组),在瓣膜置换术中应用射频探针在左心房内行直视下围绕4个肺静脉口的环形线性消融及消融环最低点与二尖瓣环连线的直线消融,输出功率30～40 W,每次放电时间45～60 s。以20例单纯行瓣膜置换术的风湿性心瓣膜病伴房颤患者为对照组,两组均同时应用胺碘酮辅助治疗,比较两组治疗房颤的疗效。患者治疗后均获得随访,平均随访(24±3)个月。结果治疗组心脏复跳后19例转为窦性心律,住院期间房颤复发2例,随访中房颤复发1例,总有效率80%(16／20)；对照组心脏复跳后16例为窦性心律,住院期间房颤复发7例,随访中房颤复发2例,总有效率35%(7/20)无心房穿孔、出血及房室传导阻滞等并发症。结论直视下射频消融肺静脉口治疗风湿性心脏病房颤有效率较高,方法简单,并发症少。Objective To evaluate the clinical efficiency of circumferential ablation around orifice of pulmonary vein by radiofrequency （RF） energy in the cure of chronic atrial fibrillation （AF） in patients with rheumatic valvular disease. Methods Radiofrequency catheter ablation was performed in 20 patients with rheumatic valvular disease and chronic AF who underwent heart valve surgery. The ablation temperature was 50-60℃ and the linear RF ablations were performed encircling the four openings of pulmonary veins and connecting the posterior mitral annulus with the probe made by ourselves especially for this ablative procedure. And amiodarone was given from the third day before the surgery and lasted for 3 months thereafter. Twenty patients with chronic AF who underwent valvular surgery but refused RF ablation were considered as the control group. Results Sinus rhythm（SR） restored in 19 patients either spontaneously or after intraoperative direct current cardioversion, immediately after the operation, as compared with 16 patients in the control group. During the follow-up （24±3） months, 16 of 20 patients （80%） remained in sinus rhythm in patients received ablation, but in control group, SR was presented in only 7 of 20 patients （35%）. Conclusions Circumferential ablation around orifice of pulmonary vein by RF energy is safe and effective in restoration and maintenance of SR in patients with rheumatic valvular disease and chronic AF.

关 键 词：心房颤动 风湿性心脏病 消融术 肺静脉 

分 类 号：R541.2[医药卫生—心血管疾病] R541.75[医药卫生—内科学]