换瓣术中单极、双极射频消融治疗风心病房颤的临床研究

Clinical study on the valve replacement surgery in unipolar,bipolar radiofrequency ablation of atrial fibrillation in the rheumatic heart disease

目的回顾分析风湿性心脏病并房颤患者在瓣膜置换术中分别应用单极射频消融、双极射频消融治疗的两组房颤病例资料,探讨两者的优缺点和临床实用价值。方法在瓣膜置换术中同期对12例患者应用国产单极射频消融机按改良迷宫法行房颤单极射频消融治疗（组一）;对70例患者应用进口双极射频消融系统按改良迷宫法方行房颤双极射频消融治疗（组二）。结果组一：随访22~30个月,无死亡;10例恢复维持窦性心律,占83%（10/12例）;2例房颤复发,占17%（2/12）。组二随访10~50个月,恢复维持窦性心律61例,占87%（61/70例）;房扑心律3例,占4.2%（3/70例）;房颤复发6例,占8.5%（6/70例）。结论双极射频消融较单极射频消融治疗风心病房颤,恢复窦性心律成功率高,安全可靠,省时,有利于心肌保护,易于操作推广,具有较好的临床实用价值。

Objective To examines the advantages and disadvantages of their clinical value.Through retrospective analysis of the purpose of rheumatic heart disease and valve replacement in patients with atrial fibrillation were applied in the unipolar radiofrequency ablation,two groups of bipolar radiofrequency ablation of atrial fibrillation patients.Methods Valve replacement in 12 patients in the same period of unipolar radiofrequency ablation with domestic machine line according to the modified maze unipolar radiofrequency catheter ablation of atrial fibrillation（group Ⅰ）;on imports of 70 patients were treated with bipolar radiofrequency ablation system according to the modified maze Bipolar atrial fibrillation ablation line shot（group Ⅱ）.Results No deaths were followed up for 22~30 months,10 patients returned to maintenance of sinus rhythm,83%（10/12 patients）,2 cases of recurrence of atrial fibrillation in 17%（2 / 12） in group I.10~50 month follow-up maintenance of sinus rhythm resumed 61 cases,87%（61/70 patients）,atrial flutter rhythm in 3 cases,4.2%（3 / 70 patients）,atrial fibrillation recurrence in 6 cases,8.5%（6 / 70 cases） in group Ⅱ.Conclusion Bipolar than unipolar radiofrequency ablation of atrial fibrillation with rheumatic heart disease,high success rate of sinus rhythm restoration,safe,reliable,time-saving benefit of myocardial protection,easy to promote,with better clinical value.