心脏直视手术中双极射频消融治疗心房颤动91例分析

Intraoperative treatment for atrial fibrillation using bi-polar radiofrequency ablation system： a clinical report of 91 cases

目的探讨心脏直视手术同期采用双极射频消融技术治疗心房颤动的方法和早、中期疗效。方法2005年3月至2007年1月共91例心房颤动患者于心脏直视手术同期接受了双极射频消融手术治疗。阵发性心房颤动5例，持续性／永久性心房颤动86例。37例采用Atricure^TM干式双极射频消融系统，54例采用Cardioblate^TM冲洗式双极射频消融系统。消融径包括标准Cox-mazem手术、改良CoxMini—maze手术和单纯左心房迷宫手术。结果平均射频消融时间（14．1±6．7）min，未发生与消融有关的并发症。围手术期死亡3例。术后2例患者安装永久起搏器，1例患者发生脑卒中及下肢动脉栓塞。随访6～29个月，双极射频消融组在术后6、12及12个月以上的成功率均高于单极射频消融组。截至末次随访，阵发性心房颤动组的非心房颤动心律为100％，持续性／永久性心房颤动组为75．3％。Atficure^TM组与Cardioblate^TM组间，以及3种射频消融路径组间的成功率无差异。结论双极射频消融技术实施简便、安全，耗时短，疗效满意，是一种更为先进的手术方法。

Objective To observe the short and mid-term therapeutic effects of bi-polar ablation systems for intraoperative treatment of atrial fibrillation （AF）. Methods From March 2005 to January 2007, 91 patients received intraoperative treatment of atrial fibrillation with hi-polar ablation systems, including 5 cases of paroxysmal atrial fibrillation and 86 persistent/permanent cases. The main concomitant heart diseases were rheumatic mitral valve diseases. Atricure^TM dry ablation system was used for 37 cases and CardioblateTM irrigated ablation system for 54 cases. The ablation lesion patterns included Cox-maze m, modified Cox Mini-maze and Left-sided maze. Results Mean ablation time was （ 14. 1± 6. 7 ） rain. No ablation-related complications occurred. Three patients died perioperatively. Two patients had permanent pacemaker implantation 3 months after operation. One case suffered from stroke and lower limb thrombosis 2.5 years after operation. Follow-up lasted for 6 to 29 months. The none-AF rhythm were 62. 5% , 85.2% , 79.0% and 74. 5% at discharge, 3 months, 6 months, and ≥ 12 months respectively. Compared to unipolar Ablation therapy group, the restoration of sinus rhythm in bi-polar group were significantly higher at 6 months and ≥ 12 months postoperatively. The latest follow-up results indicated that 100% of preoperative paroxysmal atrial fibrillation patients restored sinus rhythm and 75.3% of persistent/permanent patients were free from atrial fibrillation. The none-AF rhythm of AtricureTM group （ 81. 1% ） showed no difference from the CardioblateTM （77.5%）. Meanwhile there were no significant differences among the three ablation lesion groups. Conclusion Intraoperative radiofrequency ablation with hi-polar systems is a feasible, safe and highly effective surgical option compared to the Uni-polar ablation technique.