干式双极射频消融手术治疗器质性心房颤动  

Intraoperative treatment for atrial fibrillation using dry Bi-polar radiofrequency ablation system

作　　者：崔永强[1] 孟旭[1] 李岩[1] 韩杰[1] 王坚刚[1] 

机构地区：[1]首都医科大学附属北京安贞医院房颤诊疗中心,心脏外科9病房,100029

出　　处：《中国医药》2010年第6期522-524,共3页China Medicine

摘　　要：目的 探讨在心脏直视手术同期采用干式双极射频消融技术治疗心房颤动的方法及其早、中期疗效.方法 2005年3月至2009年8月,共有208例心房颤动患者接受了干式双极射频消融手术治疗.其中阵发性心房颤动40例,持续性/永久性心房颤动168例.消融径线包括3种：标准Cox-Maze Ⅲ手术;改良Cox Mini-Maze手术;单纯左心房迷宫手术.结果 平均射频消融时间（7.1±3.2）min,没有与消融有关的并发症出现;9例围术期死亡;3例患者因病态窦房结综合征而于术后安置永久起搏器;1例发生脑中风及下肢栓塞,总体中风率0.5%.随访5～58个月,与同期施行的单极射频消融组相比,双极射频消融组在术后6个月、12及12个月以上的成功率均高于后者.以末次随访时间分析,阵发性心房颤动组的非心房颤动心律为92.5%,持续性/永久性心房颤动组为72.1%;3种射频消融路径组间的成功率差异无统计学意义.在末次随访中,60例患者进行了相关血流动力学检测,结果示左心房收缩功能恢复率为95.0%.结论 干式双极射频消融技术实施简便、安全,耗时短,无论是实施Cox-Maze Ⅲ手术径线,还是改良的消融术式,其近期及远期疗效满意.Objective To observe the short and mid-term therapeutic effects of dry Bi-polar ablation systems for intraoperative treatment of atrial fibrillation （AF）.Methods Between March 2005 and August 2009, a total of 208 patients received intraoperative treatment of atrial fibrillation with dry Bi-pelar ablation systems, including 40 cases of paroxysmal atrial fibrillation and 168 persistent/permanent cases.The main concomitant heart operations were rheumatic mitral valve diseases.Three groups of ablation lesion patterns were included： Cox-maze Ⅲ, Modified Cox Mini-maze, Left-sided Maze.Results Mean ablation time was （7.1 ±3.2）min; no ablation-related complications occurred.9 perioperative deaths.3 patients had permanent pacemaker implantation 3～6 months after operation.1 case suffered from stroke and lower limb thrombosis 2.5 years after operation, and overall stroke rate was 0.5%.Follow-up lasted for 5～58 months.Compared to a Uni-polar Ablation therapy group during the same period, the restoration of sinus rhythm in this Bi-polar group was significantly higher at 6 months and ≥ 12 months postoperatively.The latest follow-up results showed that 92.5% of preoperative paroxysmal atrial fibrillation patients restored sinus rhythm and 72.1% of persistent/permanent patients are free from atrial fibrillation.Also among 60 patients who had left atrial dynamic observation with ultrasound cardiogram exam in the latest follow-up, 57（95.0%）restored the left atrial function with a mean Peck A-wave （89.3 ± 22.6）cm/s.Conclusions Intraoperative radiofrequency ablation with dry Bi-polar systems is a feasible, safe and highly effective surgical option.Presenting superior therapeutic outcomes, compared to the Uni-pelar ablation technique, dry Bi-pelar Radiofrequency ablation is considered to be the future direction of technology in the field of surgical treatment for atrial fibrillation in China.

关 键 词：心房颤动 心律失常手术 Cox迷宫手术 

分 类 号：R541.7[医药卫生—心血管疾病]