外科双极射频消融术治疗心房颤动406例疗效及影响因素分析  

Surgical bipolar radiofrequency ablation in the treatment of 406 cases with atrial fibrillation

作　　者：陈剑 袁武 罗勇 程力剑 王伟 陈杰 CHEN Jian;YUAN Wu;LUO Yong;CHENG Lijian;WANG Wei;CHEN Jie(Department of Cardiovascular Surgery,Chengdu Third People’s Hospital,The Affiliated Hospital of Southwest Jiaotong University,Chengdu,610031,China)

机构地区：[1]成都市第三人民医院,西南交通大学附属医院心脏大血管外科,成都610031

出　　处：《临床心血管病杂志》2020年第5期476-479,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨体外循环瓣膜置换手术同期行双极射频消融治疗心房颤动(房颤)的疗效,并分析影响疗效的因素。方法:总结分析2010年8月-2019年4月在我院行体外循环瓣膜置换手术同期行双极射频消融并存活的406例病例,其中男145例,女261例,采用Atricure双极射频消融或Medtronic双极消融系统行房颤外科双极射频消融。术后门诊随访0~5年,记录患者12导联心电图、心脏彩超资料、抗心律失常药物使用情况及射频相关并发症。结果:消融成功组与房颤复发组在术前房颤持续时间、房颤类型、左房大小、右房大小上有显著差异(均P<0.05),左室大小与射血分数(EF)差异无统计学意义。窦性心律维持组与房颤复发组EF、左房大小、右房大小比较有统计学差异(均P<0.05),左室大小无统计学差异。结论:需行心内手术合并房颤患者行同期双极射频消融术简单易行、远期效果较好。术前房颤持续时间、房颤类型、左房大小会影响房颤消融手术的治疗效果。术后左房大小、右房大小对窦性心律的维持有积极意义。Objective:To evaluate the effects and influence factors of bipolar radiofrequency ablation on patients with atrial fibrillation(AF) during cardiac valvular replacement under cardiopulmonary bypass.Method:From August 2010 to April 2019, 406 patients underwent cardiac valvular replacement operation and bipolar radiofrequency ablation was received. There were 145 males and 261 females treated with Atricure or Medtronic bipolar radiofrequency ablation. The information of electrocardiogram, echocardiography, usage of antiarrhythmic drugs and radio frequency related complications of the patients was collected during a 5-year follow-up. Result:There were significant differences in the duration of AF, AF type, left atrium size and right atrium size before the operation between successfully ablation patients and AF recurrence patients(all P<0.05). In contrast,there were no significant differences in the left ventricular size and ejection fraction(EF) between the above two groups. However, between sinus rhythm maintenance patients and AF recurrence patients, there were significant differences in the EF, left atrial size and right atrial size(all P<0.05), and no significant differences in the left ventricular size.Conclusion:Bipolar radiofrequency ablation is useful for patients to undergo cardiac valvular replacement operation. The duration of AF, AF type, left atrial size and right atrial size before the operation are interfering factors of ablation outcomes. Furthermore, left atrial size and right atrial size may be used as predictors for the persistence of sinus rhythm after the operation.

关 键 词：心房颤动 双极射频消融术 心内直视术 

分 类 号：R541.7[医药卫生—心血管疾病]