同期射频消融改良迷宫Ⅲ术+心脏神经节丛消融治疗心房颤动

Treatment of atrial fibrillation with radiofrequency modified maze Ⅲ and ganglionic plexus ablation

目的探讨心内直视下射频消融改良迷宫Ⅲ术(RFMMⅢ)+心脏神经节丛(GP)消融治疗心房颤动(AF)的方法、疗效及影响因素。方法回顾性分析2009年12月至2011年12月行RFmazeⅢ+心脏GP消融治疗心脏器质性疾病合并AF的102例患者临床资料,术后6个月定期随访。结果术后低心排出量综合征死亡1例,再次开胸止血3例,切口感染2例。术毕心电图均示非AF心律(窦性心律93.1%,节性心律6.9%),术后随访6个月,窦性心律维持率84.2%,结性心律6例(6.3%),AF复发9例(9.5%)。左房内径和AF病史是术后AF复发的危险因素(P值分别为0.027和0.040)。在先天性心脏病与后天性心脏病的射频消融术后,其AF复发率差异无统计学意义(P=0.686)。结论 RFMMⅢ+GP消融简便有效、易于操作,可明显提高射频消融的成功率,具有一定创新性和良好的发展前景,但仍需通过长期随访和更多临床应用不断发展及完善,提高远期疗效。

Objective To investigate the process, effectiveness and influence factors of radiofrequency modified maze Ⅲ （RFMM Ⅲ） and ganglionic plexus（GP） ablation in the patients with atrial fibrillation （AF） undergone open-heart surgery. Methods Retrospective analysis was used to analyze the clinical data of 102 patients who undergone RFMM Ⅲ and GP ablation treatment of valvular heart disease, congenital heart disease and coronary atherosclerosis sclerotic heart disease with AF from December 2009 to December 2011. The regular follow-up was performed for 6 months after the operation. Results 1 patient died of the low cardiac output syndrome. Re-thoratomy for homeostasis occurred in 3 cases and incision infection occurred in 2 cases. Electrocardiogram showed normal rhythm without AF after the operation （sinus rhythm 93. 1% and junctional rhythm 6.9% ）. After 6-month follow-up, the maintenance rate of sinus rhythm was 84.2%, junctional rhythm occurred in 6 patients （6.3%）, and AF recurred in 9 patients （9.5%）. Left atrial diameter and history of AF were the risk factors of the recurrence after RFMM Ⅲ and GP ablation（ P = 0. 027 and 0. 040 respectively）. After radiofrequency ablation in the congenital heart disease and the acquired heart disease, the recurrence rate of AF had no statistical difference （ P = 0. 686）. Conclusion RFMM Ⅲ and GP ablation was more effective and easy to operate, which could improve the successful rate of ablation. This operation had certain innovations and good prospects for the AF treatment, which deserved more clinical applications and long-term follow-up to enhance the long-term efficacy.