心外科手术同期行双极射频消融术治疗房颤  

Success of surgical ablation of atrial fibrillation using biopolar radiofrequency device

作　　者：过常发[1] 王春生[1] 丁文军[1] 赵东[1] 徐德民[1] 赖颢[1] 杨守国[1] 

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032

出　　处：《中华胸心血管外科杂志》2011年第12期727-730,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受上海市重点学科建设项目（编号B116）资助

摘　　要：目的总结应用双极射频消融术在心外科手术同期治疗房颤的疗效，探讨房颤近期疗效的影响因素。方法2007年6月至2010年2月，81例房颤患者被纳入研究。其中男45例，女36例；年龄（48．2±11．0）岁。合并先天性心脏病8例，冠心病16例，风湿性心脏病57例。房颤持续（7．56±7．47）年，其中永久性房颤26例，持续性房颤44例，阵发性房颤11例。左房直径36～72mm，其中小于60mm者65例。术前心功能Ⅱ-Ⅳ级。应用Atrieure双极消融系统49例，Metronic单双极消融系统32例。2009年6月至2010年2月期间22例患者进行房颤标测。所有患者均按照迷宫IV径路行双极房颤射频消融手术，同期行非体外循环冠状动脉旁路移植术（OPCAB）16例，二尖瓣置换术（MVR）[或＋三尖瓣成形术（TVP）]33例，MVR＋冠状动脉旁路移植术（CABG）1例，二尖瓣成形术（MVP）1例，主动脉瓣置换术（AVR）4例，二尖瓣主动脉瓣置换术（DVR）（或＋TVP）18例，先心纠治8例。术后随访12～44个月。结果住院期间死亡1例，无远期死亡。体外循环（105．0±26．9）min，主动脉阻断（64．1±21．4）min（OPCAB病例除外）。术后即刻、出院时及平均随访（26．1±13．6）个月时房颤消融成功率分别为100％、82．5％及84．8％。左房内径小于60mm、房颤标测患者消融成功率显著提高（P〈0．05）。结论心外科手术同期行双极房颤射频消融术是安全有效的。左房内径小于60mm、房颤标测为影响房颤近期疗效的独立影响因素，可能带来更佳的消融结果。Objective We sought to evaluate the efficacy of bipolar radiofrequency ablation of atrial fibrillation （AF） in patients undergoing cardiac surgery, and to determine independent factors affecting the recurrence. Methods From June 2007 through February 2010, 81 patients with atrial fibrillation underwent a modified Cox-Maze IV procedure using a biopolar radio- frequency device（ Medtronie in 32 cases, Atricure in 49 cases）. There were 45 males and 36 females, aged （48.2 ± 11.0） years, including 26 cases of permanent AF, 44 cases of persistent AF and 11 cases of paroxysmal AF. The mean duration time of AF was （7.56 ± 7.47 ） years. The left atrial diameter were 36 - 72 mm. In conjunction with cardiac surgery including ： mitral valve replacement （MVR） （ or add tricuspid valve plasty （TVP） in 33 cases, mitral and aortic valve replacement （DVR） （ or add TVP） in 18 cases,off-pump coronary artery bypass surgery （OPCAB） in 16 cases, aortic valve replacement （AVR） in 4 cases,MVR and coronary artery bypass grafting （CABG） in 1 case, mitral valve plasty （MVP） in 1 case,and others in 8 ca- ses. Among them, 22 patients were undergoing electrophysiologieal mapping by high-frequency bipolar stimulation from June 2009 to February 2010. A follow-up of 12 to 44 months was completed. Recurrences were evaluated by 12-lead ECG or 24 hour Hoher recording every clinic visit--1, 3, 6, 9, and 12 months after the procedure and yearly thereafter, or if symptoms devel- oped. Multivariate regression analysis was performed to determine independent factors affecting the recurrence. Results Hospital mortality was 1.23%. The successful ablation of AF were 100% , 82.5% , and 84.8% immediately after operation, at discharge, and at 2 （6.1± 13.6） months after operation respectively. Multinomial regression analysis showed small left atrium （ 〈 60 ram）, and eleetrophysiological mapping might contribute better sinus rhythm restoration （ P 〈 0.05 ）. Conclusion Bipolar radiofrequeney abl

关 键 词：心房颤动 导管消融术 心脏外科手术 房颤标测 

分 类 号：R541.75[医药卫生—心血管疾病] R654.2[医药卫生—内科学]