微创外科-导管杂交消融术在长程持续性房颤治疗中的应用及疗效  

Hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation

作　　者：梅举[1] 姜兆磊[1] 刘兴鹏 谭琛 马南[1] 刘浩[1] 汤敏[1] 沈赛娥[4] 丁芳宝[1] 朱家全[1] Mei Ju;Jiang Zhaolei;Liu Xingpeng;Tan Chert;Ma Nan;Liu Hao;Tang Min;Shen Sai'e;Ding Fangbao;Zhu Jiaquan(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092, China;Heart Center of Beijing Chaoyang Hospital AJfihated to Capital Medical University,Beijing 100020,China;The Second Cardiovascular Department,Hebei Yanda Hospital, Sanhe 065201,China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,200092 [2]首都医科大学附属北京朝阳医院心脏中心,100020 [3]河北燕达医院心内二科,三河065201 [4]上海交通大学医学院附属新华医院麻醉科,200092

出　　处：《中华胸心血管外科杂志》2018年第12期724-728,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(81570290、81600264);上海市科委科研计划项目(15411952600);上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划(16CR3087B);上海青年医师培养资助计划.

摘　　要：目的探讨"一站式"或"分期"微创外科-导管杂交消融术在长程持续性房颤治疗中的应用,并分析其治疗效果。方法2015年6月至2017年12月,应用"一站式"或"分期"微创外科-导管杂交消融术治疗长程持续性房颤56例。男38例,女18例;年龄(59.1±6.9)岁,房颤病程(5.9±3.0)年,左心房直径(45.4±4.2)mm,CHA2DS2-VASc评分(2.3±1.2)分,14例既往接受过失败的房颤导管消融术。"一站式"杂交手术30例,"分期"杂交手术26例。结果全组患者均顺利完成"一站式"或"分期"房颤杂交手术,围手术期无死亡。"一站式"杂交手术者中24例(80%)消融术中即恢复窦性心律,6例(20%)消融术后电复律恢复窦性心律;"分期"杂交手术者中22例(84.6%)消融术中即恢复窦性心律,4例(15.4%)消融术后电复律恢复窦性心律。杂交手术后随访6~36个月,平均(20.3±8.2)个月,6例(10.7%)房颤复发,50例(89.3%)维持窦性心律。其中,"一站式"杂交手术患者4例(13.3%)房颤复发,26例(86.7%)维持窦性心律。"分期"杂交手术患者2例(7.7%)房颤复发,24例(92.3%)维持窦性心律。全组患者中,6例(10.7%)房颤复发者仍继续服用华法林和胺碘酮。出院后,全组患者无死亡、无脑血管事件发生、无永久起搏器置入。 结论 "一站式"或"分期"微创外科-导管杂交消融术可安全应用于长程持续性房颤治疗,早、中期治疗效果满意。Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From Jun 2015 to Dec 2017, a cohort of 56 patients[18 female, mean age of(59.1±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation. Mean AF duration was(5.9±3.0) years. Mean left atrial diameter was(45.4±4.2)mm. Mean CHA2DS2-VASc score was 2.3±1.2. Fourteen cases had a history of prior catheter ablation. All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months, 6 months, 1 year and yearly thereafter.Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation. During ablation, LSPAF was terminated in 80.0%(24/30) with one-staged hybrid ablation and 84.6%(22/26) with two-staged hybrid ablation. At a mean follow-up of(20.3±8.2) months, 89.3%(50/56) patients maintained sinus rhythm. Among them, 86.7%(26/30) patients with one-staged hybrid ablation maintained sinus rhythm, and 92.3%(50/56) patients with two-staged hybrid ablation maintained sinus rhythm. Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy. No death or cerebrovascular events occurred. No patient required permanent pacemaker implantation.Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF. The early and midterm outcomes were satisfactory.

关 键 词：长程持续性房颤 杂交手术 微创外科消融 导管消融 

分 类 号：R541.75[医药卫生—心血管疾病]