心内直视手术中射频消融改良迷宫术治疗心房纤颤

Radiofrequency Ablation Modified Maze Procedure during Open-heart Surgery for Atrial Fibrillation

目的评价心内直视手术中射频消融(radiofrequency ablation,RFA)改良迷宫术(MazeⅢ)治疗心房纤颤(atrial fibrillation,AF)的手术疗效。方法2002年5月～2008年4月,102例风湿性心脏病(风心病)合并AF的患者接受心内直视手术,同时采用RFA改良迷宫手术,回顾性分析并随访比较手术前后心电图、超声心动图检查等指标。结果RFA改良迷宫术所需时间(15.2±4.3)min。全组无死亡。与RFA相关并发症包括:二次开胸止血1例(1.0%),心包积液2例(2.0%),Ⅲ度房室传导阻滞安置永久起搏器2例(2.0%)。术后12个月时,窦性心律恢复率79.4%(81/102)。其中左心房最大径≤55mm者12个月时窦性心律维持率明显高于左心房最大径>55mm的患者[98.3%(57/58)vs54.5%(24/44),χ2=29.265,P=0.000];房颤病程短于2年者12个月时窦性心律维持率明显高于病程长于2年者[100.0%(35/35)vs68.7%(46/67),χ2=13.814,P=0.000]。结论心内直视手术中射频消融改良迷宫术治疗AF安全可行,临床效果好。

Objective To evaluate the outcomes of radiofrequency ablation （ RFA ） modified maze （MazeⅢ ） procedure during open-heart surgery for patients with atrial fibrillation （AF）. Methods From May 2002 to April 2008, 102 patients with rheumatic heart disease complicated with atrial fibrillation underwent RFA Maze Ⅲ procedure as an adjunct to open-heart surgery in our hospital. The preoperative and postoperative records of electrocardiogram and echocardiogram were compared to determine the efficacy of the surgery. Results In this series, the mean operation time of the RFA Maze Ⅲ procedure was （15.2 ± 4.3） minutes. No patient died after the surgery; RFA-related affairs included re-open heart surgery in 1 （1.0%） , pericardia effusion in 2（2.0% ） , and permanent pacemaker for Ⅲ°AVB in 2 （2.0%）. Twelve months after the surgery, the rate of restoration to sinus rhythm was 79.4% （81/102）. The restoration rate in the patients with maximum diameter of the left ventricle ≤55 mm or course of AF less then 2 years [ 98.3% （57/58） and 100.0% （35/35） ] was significantly higher than those with maximum diameter of the left ventricle 〉 55 mm or course of AF over2 years [54.5% （24/44） and 68.7% （46/67）,Χ^2 =29.265, P=0.000 and.Χ^2 =13.814, P=0.000]. Conclusion RFA Maze Ⅲ procedure during open-heart surgery is safe and effective for patients with AF.