改良迷宫双极射频消融术治疗心房颤动的早期疗效分析

The early outcome of atrial fibrillation treated by bipolar radiofrequency ablation modified maze procedure

目的:分析瓣膜置换同期行改良迷宫双极射频消融术治疗合并心房颤动的早期疗效。方法:2011年9月至2012年9月,39例患者在瓣膜置换术同期采用双极射频消融系统,取改良迷宫手术路径治疗心房颤动。其中男性16例,女性23例,年龄23～69岁,二尖瓣置换28例,双瓣膜置换11例,同时行三尖瓣成型26例(包括5例使用成型环)。记录术前,术后当日,出院时,出院后1个月、3个月心电图分析早期疗效。并取同期同一医师单纯瓣膜置换手术89例作为对比。结果:同期射频消融术组出院时窦性心律34例,3例仍为心房颤动,房颤消除率为87.1%。术后予胺碘酮治疗3个月。出院后3个月窦性心律35例,心房颤动消除率为89.7%。对比单纯瓣膜置换组在体外循环时间、术后前3 d胸腔积液量增加差异有统计学意义(P<0.05),其余手术并发症无增加。结论:改良迷宫双极射频消融术治疗合并心房颤动安全、简便,早期疗效好。

Objective：To evaluate the early outcomes of bipolar radiofrequency ablation modified maze procedure for treating atrial fibrillation in valve replacement.Methods：From September 2011 to September 2012,bipolar radiofrequency was used to perform modified maze procedure for 39 patients with atrial fibrillation in valve replacement,including male 16 cases,female 23 cases.The age distribution was from 23 to 69 years.28 cases of mitral valve replacement,11 cases of double valve replacement,add tricuspid valve plasty in 26 cases.ECG was performed preoperatively,at ICU,and at discharge,after 1 month,3 months to determine the early effect of bipolar radiofrequency ablation modified maze procedure.89 patients who had received valve replacement by the same surgeon in the same period were divided into control group.Results： In the radiofrequency ablation group,34 patients was returned to sinus rhythm while atrial fibrillation remained in 3 patients at discharge（atrial fibrillation elimination coefficient was 87.1%）.The patients took amiodarone for 3 months.At 3-month follow-up,35 patients remained in sinus rhythm（Atrial fibrillation elimination coefficient was 89.7%）.The total drainage of the first 3 postoperative days statistics in Ablation group was more than control group（P0.05）.The CPB time of Ablation group was more than control group（P0.05）.There was no significant difference in surgical complications between Ablation group and control group（P0.05）.Conclusion： Bipolar radiofrequency ablation modified maze procedure is a safe and simple method for treating atrial fibrillation.The early outcome is very good.