心脏瓣膜置换加直视下双极射频消融治疗持续性心房颤动  

Intraoperative radiofrequency ablation for permanent atrial fibrillation during concomitant cardiac surgery

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》2014年第7期957-959,共3页China Medicine

摘　　要：目的探讨心脏瓣膜置换和心内直视下同期双极射频消融治疗心瓣膜病合并持续性心房颤动的安全性和疗效。方法回顾性分析2010年4月至2013年8月心脏瓣膜病合并持续性心房颤动70例患者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，术中采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融。消融路径包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融和Marshall 韧带切除；术后根据病情给予胺碘酮治疗3～6个月。结果70例患者手术均顺利完成，平均消融时间为（14±6） min，术后当天有62例恢复为窦性心律；其中6例分别于术后2周内发生阵发性心房颤动，经静脉持续泵入盐酸胺碘酮后5例转为窦性心律，1例于出院时仍为心房颤动心律；术后当天仍有6例为房颤心律。全组有2例围手术期出现Ⅲ度房室传导阻滞，出院前安装永久起搏器。全组无心脏穿孔，无手术死亡。患者平均住院时间为（12.3±2.1）d。术后平均随访（9±5）个月，术后6个月随访患者有82.8%（58/70）维持窦性心律,14.3%（10/70）仍为心房颤动，2.9%（2/70）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持续性心房颤动是一种简易、安全、有效的方法。ObjectiveTo summarize the clinical outcomes of modified maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of persistent atrial fibrillation （AF） and heart valve diseases. MethodsA total of 70 patients with persistent AF and heart valves diseases had surgical treatment from April 2010 to August 2013 in the Second Affiliated Hospital of Anhui Medical University, including 42 males and 28 females with age 38  76, average （50±11） years old. Rheumatic heart disease was in 65 cases and 5 cases of them suffered degenerative disease of the heart valves. The Medtronic Cardioblate 68000 flush bipolar radiofrequency ablation system was applied to all patients. Ring RF ablation procedures consisted 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 had amiodarone therapy after surgery for 3 to 6 months. ResultsThe surgery of 70 patients was successfully completed. The mean atrial fibrillation duration was （14±6） min. All patients took amiodarone hydrochloride after surgery. The day after surgery, 62 cases atrial fibrillation rhythm turned into sinus rhythm. Paroxysmal atrial fibrillation occurred in 6 cases two weeks after surgery and 5 cases turned into sinus rhythm after intravenous amiodarone. In all patients, 2 of them suffered from Ⅲ° atrioventricular block after surgery and permanent pacemakers were applicated. There were no cardiac perforation and nonhospital mortality. The average hospitalization was （12.3±2.1）d. The mean followup was （9±5） months. 82.8% （58/70） of patients had sinus rhythm, 14.3% （10/70） were in AF rhythm and 2.9% （2/70） in paced rhythm 6 months after operation.Conclusion Modified maze procedure using bipolar radiofrequency ablation is a simple, safe and effective surgical procedure for the treatment of persistent atrial fibrillation.

关 键 词：持续性心房颤动 双极射频消融 心脏瓣膜置换 

分 类 号：R654.2[医药卫生—外科学]