胸腔镜下单纯肺静脉隔离与左心房盒式消融治疗孤立性房颤的早中期疗效对比  

Video-assisted pulmonary veins isolation versus box-lesion for the lone atrial fibrillation in the mid-term follow-up

作　　者：许春雷[1] 胡秋明[1] 李岩[1] 韩杰[1] 曾文[1] 贾一新[1] 孟旭[1] 

机构地区：[1]首都医科大学附属北京安贞医院,100029

出　　处：《中华胸心血管外科杂志》2015年第5期274-277,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 对比单纯肺静脉消融及与盒式消融治疗孤立性心房颤动（房颤）的疗效.方法 2010年6月至2012年11月,80例孤立性房颤患者行外科房颤射频消融手术,其中阵发性房颤33例,47例持续性房颤.术中均同期切除左心耳及处理Marshall韧带.37例患者在双侧肺静脉隔离（PVI）的基础上增加左心房后壁两条消融径线,形成盒式消融（Box）径线,其中14例为阵发性房颤,23例为持续性房颤.术后对患者进行随访.结果 随访（18.8±7.4）个月,2例非心源性死亡.总窦性心率转复率78.8％,其中阵发性房颤窦性率87.9％,持续性房颤窦性率72.3％.在随访时间超过2年的患者中,阵发性房颤患者接受单纯PVI与Box消融的窦性转复率分别为84.6％ （11/13）和92.9％ （13/14）,P=0.45;持续性房颤患者接受单纯PVI与Box消融的窦性率分别为58.3％ （14/24）和87.5％ （14/16）,P=0.04.结论 增加左心房后壁的消融径线,可以提高孤立性房颤的治愈率,尤其对持续性房颤的效果有明显的提高.Objective To compare the mid-term results of video-assisted pulmonary veins isolation and box-lesion for lone atrial fibrillation.Methods Between June 2010 to November 2012,80 lone atrial fibrillation（LAF） patients underwent minimally invasive surgical ablation in Beijing Anzhen Hospital,and all of them received left atrial appendage excision and Marshall ligament break in the surgery.Among them,37 cases were performed two epicardial ablation lines in order to created box-lesion based on PVI（14 paroxysmal AF and 23 persistent AF）.Follow-up was finished after discharge.Results Mean follow-up was（18.8 ± 7.4） months,and 2 patients were died with non-cardiac disease.The success rate is 78.8％ （Paroxysmal AF 87.9％;Persistent AF 72.3％）.In the paroxysmal AF patients,the success rate for PVI and Box lesion treatment was 84.6％ （11/13） and 92.9％ （13/14）,P =0.45;in the persistent AF patients,the success rate for PVI and Box-lesion was 58.3％ （14/24） and 87.5％ （14/16）,P =0.04.Conclusion Addition of epicedial ablation lines might increase the cure rate for lone AF therapy,especially for persistent AF.

关 键 词：心房颤动 心脏外科手术 微创外科 

分 类 号：R541.75[医药卫生—心血管疾病]