左心房直径60～70mm心脏瓣膜手术患者同期行心房颤动消融  

Concomitant atrial fibrillation ablation with valve procedures for patients with left atrium enlarged from 60 mm to 70 mm

作　　者：刘一鸣[1] 徐明[2] 汪黎明[2] 黄福华[2] 蒋英硕[2] 邱志兵[2] 项飞[2] 陈鑫[2] 

机构地区：[1]东南大学医学院,南京210009 [2]南京医科大学附属南京医院南京市第一医院心胸外科,南京210006

出　　处：《中国胸心血管外科临床杂志》2017年第7期518-521,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：江苏省规范化诊疗课题重点病种专项(BE2015621)

摘　　要：目的评估左心房直径大于60 mm的心脏瓣膜手术患者同期行心房颤动(房颤)消融的可行性。方法前瞻性纳入我科在2013~2015年行心脏手术同期房颤消融的患者306例。按术中经食管超声心动图(TEE)测量的左心房直径,将患者分为两组:L组[左心房直径≥60 mm,93例,男55例、女38例,年龄(57.0±10.1)岁]和S组[左心房直径<60 mm,213例,男120例、女93例,年龄(55.2±9.9)岁]。分别在患者出院前、术后3个月、术后6个月和术后1年共4个时间点对其进行动态随访。据此分析左心房大小对房颤消融效果的影响。结果 S组和L组患者在术后4个时间点的房颤转复(窦性心律维持率)分别为72.8%vs.75.3%,74.2%vs.75.3%,78.9%vs.77.4%,77.0%vs.77.4%。单因素逻辑回归分析和受试者工作特征曲线分析结果均显示,S组和L组在术后4个时间点的心律转复差异无统计学意义,左心房大小与房颤消融失败无显著相关性。结论左心房直径60~70 mm的房颤患者外科消融可以取得同样满意的房颤转复,不应作为外科消融的禁忌证。Objective To explore the operability of concomitant ablation for the patients with valvular heart diseases with left atrium bigger than 60 mm. Methods We prospectively included 306 patients with concomitant ablation in our hospital between 2013 and 2015 year. Based on diameter of left atrium measured by intra-operative transesophageal echocardiography （TEE）, we separated these patients into two groups including a group L （left atrium 〉60 ram, 93 patients, 55 males and 38 females at age of 57.0_＋10,1 years） and a group S （left atrium 〈60 mm, 213 patients, 120 males and 93 females at age of 55.2_＋9.9 years） and followed them on 4 time points （time on discharge, three months, six months, and one year after surgery）. Then, we analyzed the impact of left atrial size on cardioversion outcome of surgical ablation based on the following data. Results The successful rate of the group S and the group L in the 4 time points was 72.8% vs. 75.3%, 74.2% vs. 75.3%, 78.9% vs. 77.4%, and 77.0% vs. 77.4%, respectively. The result of both univariate logistic regression analysis and receiver operation characteristic（ROC） curve analysis showed that there was no statistical difference in cardioversion rates between the group S and the group L. And there was no evident correlation between size of left atrium and ablation failure. Conclusion Patients with left atrium enlarged from 60 mm to 70 mm can achieve the same satisfactory results in cardioversion, and should not be the contraindication of concomitant surgical ablation.

关 键 词：心房颤动 消融 心律转复 左心房 

分 类 号：R654.2[医药卫生—外科学]