左心房与双心房射频消融治疗心房纤颤的对比研究

Left versus bi-atrial radiofrequency ablation in the treatment of atrial fibrillation

目的对比研究左心房和双心房射频消融治疗心房纤颤的临床疗效。方法对北京安贞医院305例房颤患者进行射频消融，160例行双心房消融，另145例行左心房消融。其中男117例、女188例，年龄24～77岁，平均（53±10）岁。房颤病史平均（36±43）个月。瓣膜手术292例，14例合并冠状动脉旁路移植术。随访3—42个月，平均（28±5）个月。结果手术死亡13例（4．3％），其中3例死于低心排综合征，7例死于多器官功能衰竭，1例死于左室破裂，1例死于猝死，1例死于心律失常。随访双心房组有3例死亡，1例死于脑出血，1例死于心功能不全，1例死因不详。全组术后窦性心律占73．1％（223／305），其中双心房组66．9％（107／160）；左心房组80．0％（116／145）（P〈0．05）。最近随访的窦性心律维持率为80．8％，左心房组为81．9％，双心房组为80．0％（P〉0．05）。随访两组之间非房颤心律比较差异无统计学意义（P=0．33）。术前左心房径线≥80mm是房颤复发的风险因素。结论左心房和双心房消融都是安全、有效的治疗房颤的外科方法。如果手术不需要切开右心房或对于重症患者，单独左心房消融是一个合理的选择。

Objective To evaluate the effectiveness of radiofrequency modified maze operation for the treatment of atrial fibrillation （AF） and compare the results of the left versus bi-atrial procedures. Methods 305 patients of organic heart disease combined with AF, 117 males and 188 females, aged （53 ± 10）, that underwent cardiac valve operation （n = 293） and/or coronary artery bypass graft surgery （ n = 14）, received concomitant atrial fibrillation, bi-atrial （ n = 160） or left atrial （ n = 145） with a mean duration of （36 ±43） months. Follow-up was conducted for （28 ±5） （3 -42） months. Results Thirteen patients （4. 3% ） died postoperatively：7 died of muhisystem and organ failure, 3 of low cardiac output, 1 of rupture of left ventricle, 1 of arrhythmia, and 1 of sudden death. During the follow-up, 1 patient died of heart failure, 1 of encephalorrhagia and 1 of unknown reason in the bi-atrial group. At the end of the procedure 223 patients （73.1%） had sinus rhythm, with a sinus rhythm rate of 66. 9% （107/160） in the bi-atrial group, significant lower than that in the left atrial group （ 80.0%, 116/145, P 〈 0. 05 ）. At late follow-up, 215 of the 266 patients （80. 8% ） were in stable sinus rhythm. Sinus rhythm rate of the bi-atrial group was 80. 0%, not significantly different from that of the left atrial group （81.9%, P 〉 0. 05 ）. The Kaplan-Meier survival analysis showed there was no significant difference in the AF rhythm rate between these 2 groups （P = 0. 33）. Logistic regression analysis showed that the left atrial diameter of ≥80 mm was an independent predictor of AF recurrence. Conclusion Both the left and bi-atrial procedures are successful in terms of restoring sinus rhythm. Left atrial ablation in severe cases and where the incision of right atrium is not needed is a reasonable choice.