完整迷宫Ⅳ手术治疗心脏疾病合并心房颤动术后近中期疗效分析  

Analysis of short and medium term effect of full mazeⅣprocedure on heart disease combined with atrial fibrillation

作　　者：孙广龙[1] 伯平[1] 曹向戎[1] 仲昭澎 张富恩[1] 高竣迪 SUN Guanglong;BO Ping;CAO Xiangrong;ZHONG Zhaopeng;ZHANG Fuen;GAO Jundi(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2022年第12期1258-1262,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结88例完整迷宫Ⅳ手术治疗心脏疾病合并心房颤动的近中期临床疗效。方法:2017年6月至2021年12月期间,应用双极射频钳+单极射频笔在进行心外科手术同时完成迷宫Ⅳ手术88例合并心房颤动的患者。所有手术均在体外循环下完成,并行循环下先完成右心房的射频消融,心脏停跳后再完成左心房的射频消融,对于双极消融不能达到的二尖瓣峡部及冠状静脉窦等部位应用单极笔进行“补消”,术后3、6、12、18及24个月分别进行随访,随访终点事件为死亡,终点时间为术后24个月或2021年12月31日。随访内容为主要心脑血管事件、24h动态心电图(Holter),以Holter出现超过15s的心房颤动或心房扑动判定为心房颤动复发。结果:全组88例患者,2例死亡,1例为术后严重低心排,1例出现感染性休克;术后3、6、12、18及24个月的心房颤动免除率分别为93.0%、87.2%、79.4%、74.1%及72.0%。结论:迷宫Ⅳ手术作为一种外科治疗心房颤动的手段,在消除心房颤动,恢复窦性心律方面具有良好的近中期疗效,而手术成功的关键是标准的消融线路,特别是峡部和冠状静脉窦的消融。Objective:To summarize the clinical effect of mazeⅣprocedure on 88 patients with heart disease combined with atrial fibrillation.Methods:From June 2017 to December 2021,88 patients of heart disease combined with atrial fibrillation underwent MazeⅣprocedure by bipolar and unipolar radio-frequency devices.All the operations were completed under cardiopulmonary bypass.Radiofrequency ablation of the right atrial was performed before aortic clamped,and the left atrial was completed after cardiac arrest.The positions of mitral isthmus and coronary sinus which the bipolar ablation cannot achieve were completed by unipolar ablation pen.Follow-up was conducted at 3,6,12,18 and 24 months postoperatively.The end point event was death,and the end point time was 24 months postoperatively or 2021.12.31.Follow-up included major cardiovascular and cerebrovascular events and 24-hour electrocardiogram(Holter).AF or atrial flutter occurred for more than 15 seconds was considered as AF recurrence.Results:Among the 88 patients,2 died,1 had severe low cardiac output and 1 had septic shock.The AF free rates at 3,6,12,18 and 24 months after operation were 93.0%,87.2%,79.4%,74.1%and 72.0%,respectively.Conclusions:As a surgical treatment for atrial fibrillation,MazeⅣprocedure has good efficacy in the short and medium term,and the key to the success of the procedure is the standard ablation line,especially the ablation of the isthmus and coronary sinus.

关 键 词：心房颤动 迷宫手术 射频消融 

分 类 号：R54[医药卫生—心血管疾病]