胸腔镜辅助微创射频消融治疗持续性心房颤动  

Video-assisted minimally invasive radiofrequency ablation in the treatment of persistent atrial fibrillation

作　　者：王坚刚[1] 孟旭[1] 韩杰[1] 李岩[1] 许春雷[1] 罗天戈[1] 王珺[1] 崔永强[1] 

机构地区：[1]首都医科大学附属北京安贞医院心血管外科,100029

出　　处：《中华外科杂志》2010年第20期1561-1564,共4页Chinese Journal of Surgery

摘　　要：目的回顾性研究胸腔镜辅助微创射频消融联合应用厄贝沙坦治疗持续性心房颤动的临床疗效。方法对2006年1月至2009年12月收治的83例持续性心房颤动患者进行胸腔镜辅助微创射频消融治疗。其中男性58例，女性25例；年龄32～79岁，平均（57±11）岁。心房颤动病史平均（61±65）个月。随访1．0～3．6年，平均（2．2±0．8）年。术后将患者随机分为厄贝沙坦组（n=42）与未用药组（n=41），比较两组心律转复情况。结果全组无手术死亡，随访期间1例猝死。全组术后窦性心律38例（45．7％），起搏心律4例（4．9％），心房扑动、房性心动过速样心律5例（6．0％），心房颤动心律36例（43．4％）。出院时窦性心律53例（63．9％），心房颤动心律24例（28．9％）。末次随访窦性心律65例（80．2％），心房颤动／心房扑动心律14例（17．3％）。厄贝沙坦组与未用药组的窦性心律和心房颤动／心房扑动心律分别为38例、3例和27例、11例，差异有统计学意义（P=0．017）。Kaplan—Meier分析显示，厄贝沙坦组与未用药组随访中的非心房颤动／心房扑动心律差异有统计学意义（P=0．020）。与未用药组相比，厄贝沙坦组心房颤动复发风险较低（RR=0．24，95％ CI：0．087～0．637，P=0．004）。结论胸腔镜辅助微创射频消融治疗持续性心房颤动安全有效，术后联合应用厄贝沙坦可以有效降低心房颤动的复发。Objective To evaluate the effectiveness of the video-assisted minimally invasive radiofrequency ablation combined irbesartan use for the treatment of the persistent atrial fibrillation （AF）. Methods From January 2006 to December 2009, 83 patients with persistent AF having a video-assisted minimally invasive radiofrequency ablation. There were 58 males, 25 females with a mean age of （57 ± 11 ） years. Mean duration of preoperative AF was （61 ±65 ） months. Follow-up for the whole patients ranged from 1.0 to 3.6 years [ mean （ 2. 2 ± 0. 8 ） years ]. Patients were randomly divided into irbesartan group （n = 42） and without irbesartan group （n = 41 ） postoperatively. Results No patient died postoperatively. During follow-up, there was 1 patient died of unknown reason. At the end of the procedure, 38 patients （45.7%） were sinus rhythm, 4 patients （4.9%） were pacing rhythm, 5 patients （6. 0% ） were atrial flutter or atrial tachycardia, and 36 patients （43.4%） were AF. Before discharge, 53 patients （63.9%） were sinus rhythm, 24 patients （28.9%） were AF. At late follow-up, 65 patients （80. 2% ） were sinus rhythm; 14 patients （ 17.3% ） were AF or atrial flutter. After follow-up, the Kaplan-Meier analysis showed the irbesartan group had fewer patients with AF （P =0. 020）. The hazard ratio for AF recurrence in patients treated with irbesartan was 0. 24 （95 % CI： 0. 087 to 0. 637, P =0. 004）. Conclusions The video-assisted minimally invasive radiofrequency ablation is safe and effective. The patients treated with irbesartan have a lower rate of recurrence of AF.

关 键 词：心房颤动 胸腔镜检查 受体 血管紧张素 2型 

分 类 号：R686[医药卫生—骨科学]