冲洗射频消融结合改良迷宫Ⅲ手术治疗瓣膜病变伴心房颤动临床研究

The treatment of saline-irrigated radiofrequency modified maze Ⅲ procedure for atrial fibrillation with valvulai heart disease

目的:探讨瓣膜手术中冲洗射频消融结合改良迷宫Ⅲ手术(IRFMM)治疗瓣膜病变伴心房颤动的临床效果。方法:在6例瓣膜手术中采用美敦力公司的外科手术射频消融系统(Medtronic CardioblateTM)治疗心房颤动。在18条迷宫Ⅲ手术切口中,5条采用常规的外科手术技术,13条采用冲洗射频消融线取代。射频功率25～30W,盐水冲洗速度180～240 ml/h。结果:6例患者手术后恢复窦性心律5例,1例仍为AF,药物复律亦无效。术后随访6～12个月,5例维持窦性心律。结论:瓣膜病变伴有较长时间持续AF者在施行瓣膜置换术的同时行冲洗射频消融结合改良迷宫III手术是安全简便,疗效确切,值得推广应用。

Objective： To report the clinical outcomes of saline-irrigated radiofrequency modified maze Ⅲ procedure （[RFMM） for atrial fibrillation in valve replacement operation. Methods： In 2 years form August 2004 to August 2006, 6 patients atrial fibrillation underwent intraoperative saline-irrigated radiofrequency modified maze 11I procedure with Medtronic CardioblateTM during valve replacement operation. In the modified maze Ⅲ procedure ,5 out of 18 incisions were treated with＂ cut and suture ＂technique, and the other 13 were with radiofrequency ablation line instead. The power of radiofrequency was 25~30W.The speeds of saline-irrigation were 180~240 ml/h. Results： AF disappeared in 5 patients, but in 1 case there was no effect, and Amiodarone had no effect either. In the 6~12 month follow-up, 5 patients remained in sinus rhythm and 1 in AF. Conclusion： Saline-irrigated radiofrequency modified maze Ⅲ procedure combined with valve replacement is a safe, simple and effective treatment for eliminating AF associated with valvulai heart disease. It is good for generalization.