永久性心房颤动外科双极射频消融术的效果

Outcomes of Maze Procedure Using Bipolar Radiofrequency Ablation for Surgical Treatment of Permanent Atrial Fibrillation

目的了解外科双极射频消融术治疗永久性心房颤动(AF)同期行风湿性心脏病瓣膜置换术的效果。方法自2006年3月至2010年10月中山大学附属第一医院收治风湿性心瓣膜病合并心房颤动患者124例,按照抛硬币法随机分成射频消融组(n=62)和对照组(n=62),比较两组患者的临床资料、体外循环(CPB)时间、主动脉阻断(ACC)时间、术后机械通气时间、ICU治疗情况、并发症及随访结果。结果两组患者临床资料比较差异无统计学意义(P>0.05)。射频消融组患者术后住院时间较对照组长[(15.8±6.1)d vs.(12.9±3.1)d,P=0.001],CPB和ACC时间两组间比较差异无统计学意义(P>0.05)。两组患者均无需放置永久起搏器,术后左心室射血分数(LVEF)两组比较差异有统计学意义(59.6%±9.2%vs.55.5%±5.4%,P<0.01)。在6个月、12个月、18个月和24个月随访时射频消融组窦性心律维持率分别为88.5%、87.5%、87.1%和82.4%,对照组分别为3.3%、2.2%、0.0%和0.0%,两组比较差异有统计学意义(P<0.05)。结论外科双极射频消融术能有效治疗永久性心房颤动。

Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation （AF） and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was （56. 1±47. 1 ） months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was （43.8 4-_ 25.6） months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass （CPB） time, aortic cross-clamping （ACC） time, mechanical ventilation time, intensive care unit （ICU） length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different （P 〉 0. 05 ）. The CPB time and ACC time between the two groups were not statistically different （P 〉 0. 05 ）. The postoperative hospital stay of ablation group was significantly longer than that of control group （ 15.8 ± 6. 1 d vs. 12. 9± 3.1 d, P=0. 001 ）. No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group （59. 6%±9. 2% vs. 55.5%±5.4%, P 〈 0. 01）. The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87. 5%, 87. 1% and 82. 4% respectively, 3.3%, 2.2%, 0. 0%, and 0. 0% in control group respectively, which was statistically different between the two groups （P 〈 0. 05）. Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.