瓣膜置换同期双极射频消融治疗合并心房颤动的早期疗效分析

The early outcome of bipolar radiofrequency ablation surgery during valve replacement in patients with rheumatic heart disease concomitant permanent atrial fibrillation

目的分析瓣膜置换同期双极射频消融治疗合并心房颤动的早期疗效。方法2006年9月至2011年5月，124例患者接受瓣膜置换同期双极射频消融治疗，其中男性36例，女性88例，年龄29-69岁，房颤时间1-12年，左心房直径为43-82（57．48±15．14）mm。全部患者均在全麻体外循环下先行双极射频消融手术，124例患者中同期接受二尖瓣置换103例、双瓣膜置换21例。另外，同期血栓清除术17例、三尖瓣成型41例（包括16例使用成型环），术毕均置人心外膜临时起搏器。记录术前，手术当日，出院时，出院后6个月、12个月心电图。结果返监护室后窦性心律113例（91．13％），交界性心律7例（5．64％），房颤4例（3．23％）。手术死亡1例（0．8％），123例痊愈出院。出院时窦性心律105例（85．37％），交界性心律4例（3．25％），房扑4例（3．25％），房颤10例（8．13％）。术后6个月内常规口服胺碘酮200mg，1次／d。术后6个月后窦性心律转为房颤1例，房颤转为窦性心律4例，房扑转为窦性心律3例，窦性心动过缓2例。结论瓣膜置换术联合双极射频消融治疗合并房颤，操作简单、安全，早期疗效好。

Objective To evaluate the effects of bipolar radiofrequency ablation during valve replacement to treat the concomitant permanent atrial fibrillation. Methods From Sep 2006 to May 2011, 124 cases who were treated by modified MAZE procedure using bipolar radiofrequency during valve replacement for treat the concomi- tant permanent atrial fibrillation, including male 36 cases, female 88 cases. The age distribution was from 29 of 69 years with an average of （42.8~ll.7）years. The atrial fibrillation last from 1 year to 12 years, and the left atri- al diameter was （57.48~15.14）mm （ranging from 43.0-82.0 mm）. All the patients were undergone modified MAZE procedure using bipolar radiofrequency under moderate hypothermic （26 cC-30 ~C） cardiopulmonary at first. Then 103 cases were undergone mitral valve replacement, and 21 cases were undergone double valve replacement procedure. The concomitant procedures of the patients included tricuspid annuloplasty in 41 patients, clearance of left atrial thrombus in 17 cases. The lead of the epicardium of a temporary pacemaker was placed on the right ven- tricle prophylactically for all patients. ECG was performed preoperatively, at ICU, and at discharge, after 6 months, 1 year to determine the effects of bipolar radiofrequency ablation. Results There were 113 patients （91.13%） with sinus arrhythmia, 7 patients （5.64%） with junctional rhythm, 4 patients （3.24%） with atrial fib- rillation as soon as the patients entered the ICU. There were no III~ trial ventricular block. One patient was dead of severe pulmonary hypertension articulo second after operation. The others were discharged from hospital and all of them were accept follow-up. There were 105 patients （85.37%） with sinus arrhythmia, 4 patients （3.25%） with junetional rhythm, 4 patients （3.25%） with auricular flutter, and 10 patients （8.13%） with atrial fibrillation at discharged. The patients took arniodarone 200 mg per day for 6 months after discharged. There were 4 patients from atrial fibrillation to sinus arrhythmia, 1 patients from auricular flutter to sinus arrhythmia, and 1 patient from sinus arrhythmia to atrial fibrillation, 2 patients with sinus bradyeardia after 6 months. Conclusion The bipolar radiofrequeney ablation during valve replacement is an simply, safely and effective method to treat the concomitant permanent atrial fibrillation. The early results are very good.