改良迷宫同期瓣膜置换联合射频消融治疗心房纤颤100例临床分析

Treatment of atrial fibrillation by modified MAZE procedure using irrigated radiofrequency

目的探讨瓣膜置换手术中射频消融改良迷宫术治疗心房纤颤的疗效。方法本科2006年3月至2009年12月期间收治的100例风湿性心脏病合并心房纤颤(atrial fibrillation,AF)患者,行瓣膜置换手术,同时采用双极射频消融改良迷宫治疗心房纤颤,回顾性分析并随访比较手术前后心电图、超声心动图检查指标。结果术毕窦性心律者91例(91.0%),交界性心律者8例(8.0%),房颤者1例(1.0%);术后6个月随访:窦性心律者80例(82.5%),交界性心律者17例(17.5%),无房颤者。无Ⅲ度房室传导阻滞发生,无因出血二次开胸,因严重心功能不全致围手术期死亡3例。结论改良迷宫同期瓣膜置换联合射频消融治疗心房纤颤操作简单,安全,治疗效果好。

Objective To evaluate the effects of modified MAZE procedure using bipolar irrigated radiofrequency ablation for treating atrial fibrillation. Methods A retrospective analysis was carried out for 100 cases with rheumatic heart disease and atrial fibrillation （38 males and 68 females,at a mean age of 45.2） from March 2006 to December 2009 in our department. This cohort underwent cardiac valve replacement and modified MAZE procedure using irrigated radiofrequency ablation during concomitant open heart surgeries. Preoperative records of electrocardiogram and echocardiogram and those postoperative records in 3 and 6 months after surgery were compared to determine the efficacy of the surgery. Results There were 91 patients with sinus arrhythmia （91.0%）,8 patients with junctional rhythm （8.0%）,and 1 patient with atrial fibrillation （1.0%） just after the operation. Three patients were dead of severe heart and lung failure during the perioperative period. In 6 months after surgery,there were 80 cases of sinus arrhythmia （80/97,82.5%）,17 cases of junctional rhythm （17/97,17.5%）,and none case of atrial fibrillation. There was no Ⅲ atrioventricular block. No patients needed the secondary thoracotomy surgery because of hemorrhage. Conclusion The modified MAZE procedure using irrigated radiofrequency is an effective method to treat atrial fibrillation.