冲洗射频改良迷宫Ⅲ手术治疗心房颤动的临床效果观察

Clinical outcomes of saline-irrigated radiofrequency modified maze Ⅲ procedure for atrial fibrillation in cardiac surgery

目的:对合并心房颤动(房颤)的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,评价冲洗射频改良迷宫Ⅲ手术在心内直视手术中治疗房颤的临床效果。方法:从2004-05开始,采用Medtronic公司的射频消融系统对115例合并房颤的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,其中包括双瓣置换术48例、二尖瓣置换术49例、主动脉瓣置换术2例、冠状动脉搭桥术同时行瓣膜置换术11例、冠状动脉搭桥术1例、三尖瓣置换术1例、其他手术3例。术后应用胺碘酮6个月。结果:115例患者手术当日109例房颤消除,其中95例为窦性心律,14例为结性心律;6例仍为房颤心律,房颤消除率为94.8%。术后随访3个月,82例维持窦性心律,10例为房性心律,房颤消除率为80%;14例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;9例仍为房颤心律。随访12～24个月,全组115例患者中80例维持窦性心律,11例为房性心律,房颤消除率为79.1%;9例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;15例为房颤。结论:冲洗射频消融改良迷宫手术在治疗合并有房颤的心脏疾病的心内直视手术中安全、简便、易于操作,而且疗效确切,值得推广应用。术中心内膜消融与心外膜消融相结合、左房显著扩大者增添左右肺静脉之间消融线;术后避免中心静脉压过高、维持正常范围内稍高的血钾浓度有利于提高房颤转复成功率和维持稳定的窦性心律。

Objective：To evaluate the outcomes of saline-irrigated radiofrequency modified maze procedure Ⅲ（IRFMM） for treating atrial fibrillation in open heart surgery. Method：Since May 2004,Medtronic Cardioblate TM was used to perform IRFMM for 115 patients with atrial fibrillation（AF） in cardiac surgery,including 48 cases of double vavular replacement,49 cases of mitral vavular replacement,2 cases of aortic vavular replacement,11 cases of CABG plus vavular replacement,1 case of CABG,1 case of tricuspid vavular replacement,1 case of mitral valvuloplasty,tricuspid valvuloplasty,ASD repair plus tricuspid valvuloplasty.All patients received amiodarone for six months postoperatively. Result：AF disappeared in 109 patients while atrial fibrillation remained in 6 patients on the operation day（AF elimination coefficient was 94.8%）.In 95 cases of these 109 patients,it was returned to normal sinus rhythm while node rhythm was present in the other 14 patients.At 3-month follow-up,82 patients remained in sinus rhythm,10 in atrial rhythm（AF elimination coefficient was 80%）,14 patients beat in sinus rhythm or node rhythm most time with short episodes of atrial flutter or atrial fibrillation.Atrial fibrillation remained in 9 patients.In the follow-up of 12～24 months,80 patients remained in sinus rhythm,11 in atrial rhythm,9 patients beat in sinus rhythm or node rhythm most time with short episodes of atrial flutter or atrial fibrillation.Atrial fibrillation remained in 15 patients. Conclusion：Saline-irrigated radio frequency modified maze procedure is a safe,simple and effective method for treating AF combined with heart disease in open heart surgery.Endocardium ablation plus epicardium ablation,more ablation line between left and right pulmonary vein ostia in the evidently enlarged left atrium,moderate CVP and potassium concentration increase ablation-success ratio.