心脏跳动中氩气刀心内膜消融治疗心脏瓣膜病合并慢性心房纤颤

Efficiency of endocardial ablation using argon beam diathermy for chronic atrial fibrillation during valve replacement:report of 15 cases

目的探讨在体外循环心脏跳动中瓣膜替换手术同时,采用氩气刀烧灼心内膜消融方法治疗慢性心房纤颤的初步经验。方法本组15例患者均为需行瓣膜替换手术的合并慢性心房纤颤的风湿性心脏病患者,男性6例,女性9例,年龄31～61(44.5±14.2)岁。经正中劈胸骨切口常规建立体外循环,浅低温心脏跳动中行瓣膜替换手术,切除病变二尖瓣后,应用氩气刀行左心房和右心房心内膜烧灼。结果全组无1例手术死亡,无发生临床脑栓塞并发症,也无1例患者发生严重房室传导阻滞。15例患者中,手术结束时13例患者房颤消失,随访术后3个月时11例患者为窦性心律。5例患者随访1年以上,4例维持窦性心律。结论心脏跳动中应用氩气刀进行心内膜烧灼是治疗慢性心房纤颤的一种经济和较为有效的方法。远期效果尚有待进一步观察。

Objective The Cox-Maze procedure is limited because of its complexity and high-cost though with proven efficacy for chronic atrial fibrillation （AF）. This paper presents our preliminary experience on endocardial ablation using argon beam diathermy for chronic AF during valve replacement on beating-heart with cardiopulmonary bypass. Methods Fifteen selected patients （6 males and 9 females, an average age of 44.5 ± 14.2） with rheumatic heart disease complicated with chronic AF underwent valve replacement and endocardial ablation using argon beam diathermy. Standard cardiopulmonary bypass was established through median sternotomy, diseased valves were replaced on beating-heart without cardioplegia perfusion and aortic cross-clam- ping. Before valve replacement, endocardial ablations were undergone using argon beam diathermy. All the patients were followed-up. Results There was no perioperative death and clinical neurological events. No patient complicated with severe heart block. Immediately after operation, 13 patients were free of AF. Of these 15 patients, 11 patients were free from AF at 3 months after operation. Among the 5 patients with more than 1 year＇ s follow-up, 4 remained sinus rhythm. Conclusion Our preliminary results are encouraging in terms of feasibility, sinus rhythms restoration and early outcomes. The long term results need further follow-up.