外科射频消融术与经导管消融术治疗瓣膜病性房颤的疗效对比

Catheter ablation and surgical treatment of atrial fibrillation with valvular heart disease

目的比较心内直视下射频迷宫术与介入导管消融术治疗合并心脏瓣膜病的心房颤动临床结果。方法2004年1月到．2006年3月因心脏瓣膜病合并心房颤动行瓣膜置换时加射频迷宫术60例，其中男34例，女26例；平均（57±11）岁。瓣膜置换术后在三维电解剖标测系统（CARRTO）指导下进行经皮经导管环肺静脉消融治疗66例，其中男40例，女26例；平均（55±10）岁。结果导管消融组随访（14±10）个月，窦性心律维持率64％。外科射频迷宫组随访（13±9）个月，窦性心律维持率75％，二者差异有统计学意义（P〈0．05）。对于病史小于1年、左房直径〈50min的阵发性房颤，导管消融组亦有较高的窦性心律维持率（分别为90％、82％）。两组术后并发症无显著性差异。结论射频迷宫术对瓣膜病合并心房颤动病人是简单、有效的治疗方法。若未行迷宫术，对于病史小于1年，左房直径小于50min的阵发性心房颤动．瓣膜置换术后行经皮经导管消融术亦为一种有效的治疗方法。

Objective Catheter ablation of atrial fibrillation（AF） has become another nonpharmacologic therapeutic option for valvular heart disease with AF. The modified Cox maze procedure was the traditional treatment of AF during cardiac surgery. The purpose of this study was to compare the clinical outcomes of the two approaches in patients with rheumatic valvular heart disease and AF. Methods From January 2004 to March 2006, patients with valvular heart disease with AF were included. Catheter ablation（ group 2） versus surgical treatment（ group 1） for rheumatic heart disease with AF. Remits Group 1 and2 didnot differ in terms of baseline characteristics. The perioperative mortality rate was not significantly different between the two groups. The maintenances of sinus rhythm were 90%, 82% respectively for group 2 in paroxysmal AF with LAd 〈 50 mm, and case history 〈 1 year. The overall cumulative rate of sinus rhythm were 75% in group 1 [（14±10） months] and 64% in group 2 [follow-up time, （14±10） months] , statistically significant. Conclusion The radiofrenquency （RF） ablation procedure during surgical treatment for valve heart disease with atrial fibrillation is a simple, effective therapeutic option, allowing recovery of the sinus rhythm in the great majority of patients with atrial fibrillation. While catheter ablation is also a safe and effective means of curing atrial fibllation in paroxysmal AF with LAd 〈 50 mm （ 〈 1 year）.