心脏手术同期射频消融治疗房颤的中长期疗效分析  

Mid-long term outcomes of surgical ablation for atrial fibrillation during concomitant cardiac surgery

作　　者：顾闻达 郭惠明[1] 卢聪[1] 黄焕雷[1] 谢斌[1] 张晓慎[1] 郑少忆[1] 黄劲松[1] 

机构地区：[1]广东省医学科学院广东省心血管病研究所广东省人民医院心脏外科,510100

出　　处：《中华胸心血管外科杂志》2016年第3期147-150,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：“十二五”国家科技支撑计划（2011BAI11B19）,广东省公益研究与能力建设专项资金（2014A020212403）

摘　　要：目的探讨心脏手术同期行射频消融治疗房颤的中长期手术疗效及影响手术效果的相关危险因素。方法回顾性分析2004年10月至2014年3月1003例心脏直视手术同期行射频消融术的患者临床资料。以随访期内死亡、房颤或房扑复发作为复合终点，分为复合终点组和窦性心律组，使用单因素、多因素比较，Kaplan—Meier生存分析评估可能影响手术效果的危险因素。结果术后早期死亡11例，其余992例患者顺利出院。有效随访895例（90．2％），中位随访时间（30．0±22．4）个月。术后1、2、3年窦性心律维持率分别为88．9％、81．8％、72．6％。影响心脏手术同期射频消融治疗房颤疗效的危险因素包括出院心律为房颤或房扑（HR=3．20，95％CI：2．53～4．05）、术前左心房内径≥50mm（HR=1．36，95％CI：1．06-1．75），术前右心房内径≥55mm（HR=1．60，95％CI：1．24～2．07），患者年龄〉160岁（HR=1．39，95％CI：1．09-1．77）。结论心脏手术同期行射频消融治疗房颤的手术效果满意，出院心律为房颤或房扑、术前左心房内径≥50mm，术前右心房内径t〉55mm，患者年龄〉160岁是影响手术效果的独立危险因素。Objective To evaluate the clinical course of surgical ablation of atrial fibrillation during concomitant cardiac surgery and to identify the independent risk factors for recurrence of atrial fibrillation, atrial flutter or death. Methods Retro- spective analysis was made in 1 003 surgical ablation cases from October 2004 to March 2014. They were divided into two groups according to composite endpoints including death, recurrence of atrial fibrillation or atrial flutter. Risk factors were iden- tified using univariate analysis, Cox regression analysis and Kaplan-Meier survival analysis. Results 895 of 992 （ 90.2% ） survival cases at discharge were followed up. The rate of freedom from composite endpoints at 1, 2, 3 years was 88.9% , 81.8% ,72.6% , respectively, with a median follow-up time of（ 30.0 ± 22.4） months. Independent risk factors of ablation failure were atrial fibrillation or atrial flutter at discharge（ HR = 3.20,95% CI： 2.53 - 4.05 ）, left atrium diameter ≥ 50 mm （HR = 1.36,95% CI： 1.06 - 1.75 ）, fight atrium diameter i〉 55 mm （ HR = 1.60,95% CI： 1.24 - 2.07 ）, age/〉 60 years （ HR = 1.39, 95 % CI： 1.09 - 1.77 ）. Conclusion Surgical ablation has a high success rate. Atrial fibrillation or atrial flutter at discharge, left atrium diameter≥50 mm, right atrium diameter≥55 mm and age≥60 years are the major independent risk factors of ablation failure.

关 键 词：心房颤动 导管消融术 心脏外科手术 危险因素 

分 类 号：R541.75[医药卫生—心血管疾病]