心房迷宫式射频消融治疗心房颤动

Atrial radiofrequency maze procedure for the treatment of atrial fibrillation

目的：探讨经心外膜迷宫式射频消融心房治疗心房颤动（房颤）的可行性。方法：对６例风湿性心脏病合并房颤患者〔持续性房颤史３．３±２．７年，左心房直径３４．７±５．３ｍｍ，心功能（ＮＹＨＡ分级）Ⅱ～Ⅳ级〕，在瓣膜置换或分离术后继续在开胸状态下分别环形消融左右心耳根部及其间横窦、上下腔静脉之间及右房前壁和冠状窦。结果：６例患者术后均恢复窦性心律。平均射频消融加瓣膜手术时间为３．０±０．７小时。无一例术中及术后发生心房穿孔或Ⅲ度房室传导阻滞。心功能较术前显著改善（Ｐ＜０．０５）。术后随访１２～２０个月，除１例患者于第８个月恢复房颤外，余均维持窦性心律。结论：本方法可以达到治疗房颤的目的。

Objective:To investigate the availability of transepicardial atrial radiofrequency maze procedure in treating atrial fibrillation.Methods:Six patients with atrial fibrillation due to rheumatic heart disease were studied.Their history of sustained atrial fibrillation was 3 3±2 7 years.The diameter of left atrium was 37 4±5 3mm.The heart function (NYHA grading)was grade 24. After valvular replacement or commissurotomy,the atrial radiofrequency maze procedure was performed around the roots of left and right atria,in the transverse sinus,between the superior vena cava and the inferior vena cava,in the anterior wall of right atrium and in the coronary sinus.Results:After radiofrequency maze procedure,sinus rhythm reco vered in all patients.The total time of radiofrequency maze procedure and valvular opertation was 3 0±0 7 hours averagely.No patients were found to have atrial perforation or Ⅲ degree atrioventricular block.The heart function was significantly improved as compared with that before operation( P <0 05).After 1220 months′ follow up,only one of the six patients was found to have a recurrence of atrial fibrillation eight months later.Conclusions:Atrial radiofrequency maze procedure can be used for treating atrial fibrillation.