分期杂交微创外科-导管消融术治疗长程持续性房颤的疗效分析  

Two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation

作　　者：姜兆磊[1] 梅举[1] 汤敏[1] 丁芳宝[1] 黄健兵[1] 马南[1] 刘浩[1] 沈赛娥[2] 蔡捷 JIANG Zhao-lei;MEI Ju;TANG Min;DING Fang-bao;HUANG Jian-bing;MA Nan;LIU Hao;SHEN Sai-e;CAI Jie(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,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,上海市200092 [2]上海交通大学医学院附属新华医院麻醉科,上海市200092

出　　处：《中国心血管病研究》2022年第4期293-297,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(82170324,81974023);上海市科委科研计划项目(19411963800,20Y11910700)。

摘　　要：目的 总结分期杂交微创外科-导管消融术治疗长程持续性心房颤动(房颤)的方法,并分析其疗效。方法 选取2016年6月至2020年12上海交通大学医学院附属新华医院心胸外科应用分期杂交微创外科导管消融术治疗长程持续性房颤62例(女25例)。平均年龄(60.4±6.2)岁,平均房颤病程(4.9±2.3)年,平均左心房直径(46.3±4.9)mm,平均CHA2DS2-VASc评分为(2.5±1.3)分,平均左心室射血分数(LVEF)为(57.2±2.8)%。16例患者既往曾接受过失败的房颤导管消融术。所有患者术后3、6、12个月、每年随访时,均作24 h或72 h动态心电图检查。回顾分析患者临床资料,总结分期杂交微创外科导管消融术治疗长程持续性房颤的方法,并评价其治疗效果。结果 全组患者均顺利完成分期杂交微创外科导管消融术,两期手术间隔时间为4~10(5.7±0.8)个月,围术期无死亡病例。56(90.3%)例消融术中即恢复窦性心律,6(9.7%)例消融术后电复律恢复窦性心律。术后随访12~66(29.8±13.5)个月,8(12.9%)例患者术后复发,54(87.1%)例患者维持窦性心律。Kaplan-Meier曲线表明术后2年时窦性心律维持率为(87.4±4.5)%。全组患者无死亡、无脑血管事件发生,1例患者植入心脏永久起搏器。结论 分期杂交微创外科导管消融术可安全、有效地应用于长程持续性房颤治疗中,治疗效果满意。Objective To explore the application and effectiveness of two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From June 2016 to December 2020,62 patients(25 female,mean age of 60.4±6.2 years) with long-standing persistent atrial fibrillation underwent two-staged hybrid minimally invasive surgical and transcatheter ablation in Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University.Mean AF duration was(4.9±2.3) years.Mean left atrial diameter was(46.3±4.9) mm.Mean CHA2DS2-VASc score was(2.5 ± 1.3).Mean left ventricular ejection fraction(LVEF) was(57.2 ± 2.8)%.Sixteen cases had a history of prior catheter ablation.All patients underwent continuous 24 hours or 72 hours holter monitoring at 3 months,6 months,1 year and yearly thereafter during the follow-up.Results All the patients successfully underwent two-staged hybrid minimally invasive surgical and transcatheter ablation.Fifty-six cases(90.3%) recovered to sinus rhythm during the hybrid ablation.Six cases(9.7%) required electrical cardioversion to terminate the AF after transcatheter ablation.At a mean follow-up of(29.8 ± 13.4) months,87.1%(54/62) patients maintained sinus rhythm.The maintenance rate of sinus rhythm at two years was(87.4±4.5)%.No death or cerebrovascular events occurred.One patient required permanent pacemaker implantation.Conclusion Two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF with satisfactory results.

关 键 词：长程持续性房颤 分期杂交手术 微创外科消融 导管消融 

分 类 号：R654.2[医药卫生—外科学]