心脏瓣膜置换同期双极射频消融术治疗心房纤颤的短期疗效观察

Short-term results of clinic treatment of atrial fibrillation association with valve disease by bipolar radiofrequency ablation

目的探讨瓣膜置换同期双极消融治疗心房纤颤(AF)的短期疗效。方法对14例瓣膜置换同期双极消融治疗心房纤颤的患者进行回顾性分析,观察其早期治疗效果。结果全组患者术前房颤时间(28.6±13.5)个月,转机时间(88.7±10.4)min,主动脉阻断时间(41.7±8.2)min,无围手术期死亡,患者出院时全部恢复窦性心律,无一例安置永久起搏器,随访3～6(4.7±1.2)个月,13例保持窦性心律,晚期死亡1例。结论心脏瓣膜置换手术同期行双极射频消融术与传统的Cox迷宫治疗AF相比,能简化手术操作并缩短主动脉阻断时间,是一种简便、安全、有效的治疗方法,值得在临床推广应用。

Objective To observe the short-term results of patients who underwent valve replacement operation combined with bipolar radiofrequency ablation （RFA） modified Cox-Maze procedure. Methods From October 2009 to March 2010, 14 consecutive patients underwent valve replace operation combined with a modified Cox-Maze procedure with bipolar radiofrequency ablation for AF; the short-term results were analyzed retrospectively. Results The mean preoperative AF duration was （28.6±13.5）months. The mean perfusion and cross-clamp times were （88.7 ± 10. 4） min and （41.7 ± 8.2） rain, respectively. No preoperative death. No patient required implantation of a permanent pacemaker. During discharge, all patients were in sinus rhythm. Patients were followed up for a mean duration of （4. 7±1.2）months （range： 3 -6 months）. During follow-up period, 13 patients （93.4%） remained in sinus rhythm,late death occurred in one patient. Conclusion Valve replace operation combined with bipolar radiofrequency ablation （RFA） modified cox maze procedure is a safe and efficient method to patients with valvular disease of the heart and atrial fibrillation. The use of bipolar RF energy significantly decreased cross-clamp times and simplified the procedure compared to the traditional Cox-Maze procedure, potentially increasing utilization of the procedure a- mong cardiac surgeons.