单双极射频消融改良迷宫术用于瓣膜病合并心房颤动的疗效  

Effects of monopolar and bipolar radiofrequency modified Maze procedure in patients with atrial fibrillation and concomitant valvular heart disease

作　　者：叶伟[1] 张卫[1] 石暐[1] 张倞[1] 孔烨[1] 

机构地区：[1]上海交通大学附属胸科医院心血管外科,200030

出　　处：《国际心血管病杂志》2014年第3期202-205,共4页International Journal of Cardiovascular Disease

摘　　要：目的:探讨单极与双极射频消融改良迷宫术在心脏瓣膜手术中治疗心房颤动(房颤)的疗效及安全性。方法:连续入选2010年1月至2012年12月在我院行心脏瓣膜手术,同期行射频消融改良迷宫术的患者137例。根据射频消融系统的不同,分为单极射频消融组(n=56)及双极射频消融组(n=81)。比较两组患者术中射频消融时间、围术期严重并发症的发生率及死亡率、术后房颤消除率及心功能等临床指标。结果:两组围术期严重并发症的发生率及死亡率无统计学差异。术中两组消融所需时间亦无统计学差异。两组患者术后1年的心功能分级均较术前改善,左房内径明显减小(P<0.01)。与单极消融组相比,双极消融组同期的房颤消除率显著提高(P<0.05)。结论:心脏瓣膜手术同期行射频消融迷宫术是治疗心脏瓣膜疾病合并房颤安全、有效的方法。与单极射频消融相比,双极射频消融的房颤消除率更高,具有较好的临床应用价值。Objective：To evaluate the efficacy and safety of monopolar and bipolar radiofrequency modified Maze procedure in patients with valvular heart disease and atrial fibrillation.Methods：A cohort of 137 patients were involved from January 2010 to December 2012 in our hospital.Heart valve surgery and Maze procedure with radiofrequency ablation were performed.According to radiofrequency ablation system,patients were assigned to monopolar radiofrequency ablation group （n =56）and bipolar radiofrequency ablation group （n =81）.After procedures,clinical factors such as ablation time,the incidence of severe complications,mortality,the elimination rate of atrial fibrillation and heart function were compared between the two groups via follow-ups.Results：There was no statistical difference in ablation time,incidence of severe complications and mortality between the two groups.Post operation heart function was improved with marked reduction of left atrial diameter in both groups （P＜0.01）.Compared with monopolar radiofrequency ablation,bipolar radiofrequency ablation improved the elimination rate of atrial fibrillation during operation and follow-up （P ＜ 0.05）.Conclusion：Maze procedure with radiofrequency ablation in heart valve surgery is safe and effective for valvular heart disease combined with atrial fibrillation.Bipolar radiofrequency ablation has advantages over monopolar ablation in the elimination rate of atrial fibrillation.

关 键 词：心脏瓣膜疾病 心房纤颤 迷宫术 射频消融 

分 类 号：R654.2[医药卫生—外科学]