非体外循环下心外膜微波消融治疗心房颤动的临床效果

Clinical effect of off-pump epicardial microwave ablation of atrial fibrillation

目的 探索非体外循环下心外膜微波消融术治疗心房颤动（房颤）的临床应用效果.方法 从2003年4月至2005年4月对46例持续性房颤患者进行了非体外循环下心外膜消融术,其中二尖瓣病变28例、二尖瓣合并主动脉病变5例,冠心病8例、孤立性房颤5例.将FLEX 10微波探头完整包绕4个肺静脉入口及下腔静脉开口至三尖瓣环,微波能量65 W、90 s进行连续性心外膜消融,然后在体外循环下行瓣膜置换术或不停跳冠状动脉旁路术.术前平均左房直径（52.5±15.3）mm, 左室射血分数42%～70%.所有病例均于出院时和术后3、6、12个月行标准12导联心电图、24 h Holter、超声心动图及临床检查进行随访.结果 本组病例均成功进行了心外膜微波消融术并于术中消除房颤,无手术死亡及手术相关的并发症.微波消融时间平均（37.7±7.8） min,成功率为63.0%;随访窦性心律维持率：出院时为63.0%,3个月为66.7%,6个月为72.7%,12个月为80.6%,且左房内径＜50 mm.结论 非体外循环下心外膜微波消融术可以达到肺静脉电学隔离治疗房颤的目的,在合并或不合并心脏器质性病变的持续性房颤外科治疗中有较低的风险和良好效果.

Objective To apply the off-pump epicardial microwave ablation （MW） to treat the permanent atrial fibrillation （PAF） and evaluate the clinical effect. Methods From April 2003 to April 2005, a total of 46 patients with PAF underwent off-pump epicardial MW, including the patients with mitral valve disease （28 cases） , mitral and aortic valve disease （5 cases）, coronary artery disease （8 cases） and lone PAF （5 cases）. FLEX 10 probe was placed around four pulmonary orifices and the access orifice of the inferior vena cava to tricuspid annulus. The microwave application was set 65 W, 90 s and a continuous ablation line was finished encircling the pulmonary veins. Subsequently, patients underwent either off-pump coronary artery bypass graft or valve surgery on-pump. Mean left atrial diameter was （52.5 ± 15.3） mm, LVEF 42% -70% before operation. All patients were followed up in the discharge, 3, 6, 12 months after surgery by standard 12-lead ECG, 24 h Holter, UCG and clinical examination. Results All procedures were completed successful on the off-pump cardiac surgery and 46 patients were converted sinus rhythm when the operations were performed. Mean ablation time was （37. 7 ± 7. 8 ） rain, without any related complications. At discharge, 3, 6 and 12 months follow-up, 63.0%, 66.7%, 72.7% and 80.6% of the patients kept sinus rhythm and left atrial diameter of 〈 50 mm. Conclusions Using MW, electrical isolation of the pulmonary veins can be achieved epicardially without cardiopulmonary bypass support. Off-pump epicardial microwave ablation is an efficient option with an excellent benefit/risk ratio for the treatment of PAF with or without other cardio-surgical disease.