双极射频消融心房颤动同时手术治疗器质性心脏病的临床效果

Clinical experience of bipolar radiofrequency ablation for atrial fibrillation under open heart surgery for organic heart disease

目的:探讨双极射频消融钳治疗心房颤动同期行开胸手术治疗器质性心脏病的手术方法和临床结果,提高对此类疾病的治疗水平。方法:回顾分析2009年8月～2012年5月对58例器质性心脏病并发心房颤动用双极射频消融钳治疗房颤的临床资料。结果:本组患者手术均顺利完成。射频时间16～38(24±4)min,主动脉阻断时间64～200(126±36)min,体外循环时间91～238(150±37)min;手术结束及出院时窦性心率分别为46(79%),45(78%)例,随访3个月,6个月和12个月,窦性心率分别为41(71%),40(69%)和42(72%)例。全组病例无手术死亡和射频相关并发症。所有患者均无需安装永久起搏器。双心房消融与单独左房消融比较无显著差异。结论:此方法可行,效果满意,但要注意把握适应证。

AIM：To discuss the methods and results of bipolar radiofrequency ablation （RFA） for atrial fibrillation （AF） under open heart surgery for organic heart disease （OHD） so as to improve the therapy for this disease. METHODS： Clinical data of 57 patients with OHD and AF who underwent open heart surgery with concomitant bipolar RFA from August 2009 to May 2012 were analyzed retrospectively. Postoperative data were collected at the time of discharge and at 3, 6 and 12 months after operation. RESULTS： All operations were successful. Cardiopulmonary bypass, aortic clamp and RFA were （150±37）, （126±36） and （24±4） min, respectively. Normal sinus rhythm was achieved in 46 （79%） at the end of operation and in 45 （78%） patients at discharge, and in 41 （71%）, 40 （69%） and 42 （72%） patients at 3, 6 and 12 months postoperatively. There were no RFArelated hospital mortalities and no complications. No patients required permanent pacemakers. Risk factors for ablation failure included longer duration of AF and larger left atrial diameter. CONCLUSION： RFA is a safe, easy and effective treatment for OHD patients with AF, with lower complication rates and high rates of restoring sinus rhythm.