风湿性心脏病瓣膜置换术中射频消融迷宫术治疗心房颤动  

Ablation of chronic atrial fibrillation by radiofrequency maze procedure during valve replacement

作　　者：俞世强[1] 蔡振杰[1] 周更须[1] 杜日映[1] 万明明[1] 王红兵[1] 

机构地区：[1]第四军医大学西京医院心脏外科,陕西西安710033

出　　处：《第四军医大学学报》2004年第9期851-853,共3页Journal of the Fourth Military Medical University

摘　　要：目的 :总结射频消融迷宫术治疗风湿性心脏病慢性心房颤动 8a临床经验及体会 .方法 :以射频消融的方法替代“切和缝” ,完成迷宫手术即射频消融迷宫术 ,共施行 2 36例 ,对其中后 1 6 6例患者的经典迷宫手术路线进行了改良 ,包括在右心房下部行三条短线性射频消融 ,在左心房长径 >70mm、房颤病史 >3a的病例增加左心房消融线路 .结果 :整个射频消融过程耗时 1 3～ 39(平均 2 1 )min .无手术死亡 ,无射频消融相关并发症 .手术后 2wk 2 1 0例恢复窦性心律 ,总转复率89% ,其中前 70例患者有 5 1例恢复窦性心律 ,转复率 73% ,后 1 6 6例患者有 1 5 9例恢复窦性心律 ,将手术后恢复窦性心律的比例提高到 95 .7% (P <0 .0 1 ) .前 70例中有 6 3例曾发生手术后心房扑动 ,但在后 1 6 6例 ,行射频迷宫术时在右心房下部加三条短线性消融后 ,仅有 5 8例患者术后短期内发生心房扑动 ,占 35 % ,明显少于经典迷宫手术路线组 (P <0 .0 1 ) .结论 :射频消融迷宫术简便易行 ,与“切和缝”的迷宫手术比较明显缩短手术时间 ,并发症少 ,手术疗效确切 ,经过改良路线 ,房性心律失常并发症减少 ,房颤窦性转复率高于经典的“切和缝”AIM: To report 8 year experiences of surgical treatment of chronic atrial fibrillation by radiofrequency maze procedure. METHODS: Maze procedure was performed in 236 patients by radiofrequency ablation instead of classic “cut and sew” procedure. Of the 236 patients, 166 patients were treated with modified maze procedure, in which lines were modified, including adding 3 line ablation in the lower right atria, adding 2 line ablation in left atria in patients, with atrial fibrillation >3 years, left atria dimension >70 mm and amplitude f wave <0.2 mV. RESULTS: The radiofrequency maze procedure only took 13-39 (mean 21) min for aortic clamping and there was no death or complications related to ablation. 210 patients converted to normal sinus rhythm (89%) two weeks after operation. Of the 70 patients treated with unmodified procedure, 51 converted to sinus rhythm (73%), while of the 166 patients treated with modified procedure, 159 converted to sinus rhythm (95.7%, P <0.01). Sixty three (90%) patients out of the 70 patients had atrial flutter, while only 58 (35%) out of the 166 patients had atrial flutter ( P <0.01). CONCLUTION: Radiofrequency maze procedure is much simpler than the classic cut and sew maze procedure and its aortic clamping time averages only 21 minutes. Radiofrequency maze procedure with modified lines has a higher conversion rate to sinus rhythm compared with the classic maze procedure.

关 键 词：风湿性心脏病 心房颤动 迷宫术 射频消融 

分 类 号：R654.2[医药卫生—外科学]