心内直视房颤射频消融术前危险因素与术后转律关系  

Risk analysis on postoperative recurrence of atrial fibrillation after bipolar radiofrequency ablation undergoing open heart procedures

作　　者：韦俊[1] 张大发[1] 刘志勇[2] 陆启同[2] 刘德森[2] 

机构地区：[1]皖南医学院弋矶山医院胸心外科,芜湖241001 [2]东南大学附属中大医院胸心外科

出　　处：《中华胸心血管外科杂志》2012年第4期223-226,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的回顾性分析同期瓣膜置换术加房颤射频消融术患者术前危险因素与手术成功率之间的关系。方法选取52例风湿性心脏病合并永久性房颤同期行瓣膜置换术加房颤射频消融术患者，术后随访半年以上，根据是否转为窦性心律分为转律组（SR）与房颤组（AF），采集并比较两组患者的围术期资料，单变量分析采取t检验或方差检验。差异有统计学意义的指标行logistic回归分析，计算优势比（OR）及95％可信区间（95％CI）。结果最后一次随访中37例患者转为窦性心律，手术成功率约71．2％。单因素分析显示房颤病程、左心房内径、左心室舒张末期容积及主动脉阻断时间是术后房颤复发的危险因素，多因素分析显示房颤病程是术后房颤复发的独立危险因素。结论瓣膜置换术同期行房颤射频消融术是治疗慢性房颤的有效方法。房颤病程短、左心房内径小的患者行房颤双极射频消融成功率高。Objective Surgical radiofrequency （RF） ablation has recently been one of the most effective means to treat chronic atrial fibrillation（AF）. However, about 20% to 30% patients have shown recurrence of AF during the follow-up period. This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years. We compared the information and clinical date in the sinus rhythm（SR） group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure. The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges. Methods From June 2006 to June 2009, 52 patients with rheumatic heart disease （RHD） and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method. Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm. Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram. We divided all patients to the SR grope and AF grope. Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-, intra- and postoperative period. Results There was only one case in-hospital mortality （ 1.9% ）. None mortality, re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months （9-35 months）. At the last follow-up, sinus rhythm was shown in 71.2% （37/52） patients. In univariaye analysis, the left atrial diameter, AF duration, left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF. Age, left ventricular ejection factor, cardiopulmonary bypass time showed no

关 键 词：心房颤动 危险因素 导管消融术 心脏外科手术 

分 类 号：R541.75[医药卫生—心血管疾病]