心脏瓣膜置换术同期双极射频消融治疗永久性心房颤动  

Outcomes of modifiedmaze procedure using bipolar radiofrequency ablation for surgical treatment of permanent atrial fibrillation

作　　者：曹炜[1] 石开虎[1] 徐盛松[1] 沙纪名[1] 

机构地区：[1]安徽医科大学第二附属医院心胸外科,合肥230601

出　　处：《中国医药》2013年第10期1370-1372,共3页China Medicine

摘　　要：目的探讨心内直视下同期行改良冲洗式双极射频消融治疗心瓣膜病合并永久性心房颤动的临床效果。方法回顾性分析2010年4月至2013年4月心脏瓣膜病合并永久心房颤动52例患者在体外循环下行心瓣膜置换术加改良冲洗式双极射频消融手术的临床资料。其中风湿性心脏瓣膜病47例，心瓣膜退行性病变5例；均合并永久性心房颤动，术中采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融操作。消融手术包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融（改良Cox—maze Ⅲ手术路径）和Marshall韧带切除；术后常规予胺碘酮治疗。结果52例手术均顺利完成，平均消融时间为（14±6）min，全组无心脏穿孔，无手术死亡。术后当天有42例恢复为窦性心律。全组术后均予以口服盐酸胺碘酮维持6个月，有5例分别于术后1～7d发生阵发性心房颤动，经静脉注射盐酸胺碘酮后转为窦性心律。2例出现Ⅲ度房室传导阻滞，安装永久起搏器治疗，患者平均住院时间为（12．1±2．3）d。术后平均随访（8±4）个月，84．6％（44／52）维持窦性心律，11．5％（6／52）为房颤心律，3．8％（2／52）为起搏心律。结论心内直视下同期改良冲洗式双极射频消融治疗心脏瓣膜病合并永久性心房颤动是一种简易、安全、有效的方法。Objective To summarize the clinical outcomes of modified maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation （AF） and heart valve diseases. Methods A total of 52 patients with permanent AF and heart valves diseases were undergone surgical treatment from April 2010 to April 2013 in the second affiliated hospital of Anhui medical university. Rheumatic heart disease was 47 cases and 5 cases of them had suffered degenerative disease of the heart valves. The medtronic cardioblate 68000 flush bipolar radiofrequency ablation system applied to all patients. Ring RF ablation procedures was consisted of bilateral pulmonary vein isolation, left atrial appendage resection, left and right atrial ablation （modified Cox-maze III surgical path） and Marshall ligament resection. All patients were taken amiodarone therapy after surgery. Results The surgery of 52 patients was successfully completed. The mean atrial fibrillation duration was （14 ±6） min. All patients taked amiodarone hydrochloride after surgery. The day after surgery, 42 cases atrial fibrillation rhythm turned into sinus rhythm ; paroxysmal atrial fibrillation occurred in 5 cases after 1 to 7 days after surgery and turned into sinus rhythm after intravenous amiodarone. In all patients, 2 cases had suffered III ° atrioventricular block after surgery and permanent pacemakers were implanted. There were no cardiac perforation and hospital mortality. The average length of stay was （ 12.1 ±2.3 ） d. The mean follow-up was （ 8 ± 4） months. 84.6% （44/52） of patients remained in sinus rhythm, 11.5% （6/52） had AF rhythm and 3.8% （2/ 52） had paced rhythm. Conclusion Modified maze procedure using bipolar radiofrequency ablation is a simple, safe and effective surgical procedure for the treatment of permanent AF.

关 键 词：心房颤动 心脏瓣膜置换 双极射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]