成人继发孔型房间隔缺损并发房颤患者三种治疗方法分析

Treatment strategies for secundum atrial septal defect with atrial fibrillation in adult patients

目的:介绍成人房间隔缺损(ASD)并发心房颤动(AF)患者的几种治疗方法,并分析其治疗效果。方法:回顾分析本院136例ASD并发有明显临床症状且药物治疗无效的AF病例,其中36例接受介入封堵+经导管射频消融术(导管射频消融组),84例体外循环下ASD补术+改良迷宫术(改良迷宫组),16例单纯介入封堵术(未行经导管射频消融术,单纯介入封堵组),术前,术后12月用心脏超声仪评价右心房、右室内径及肺动脉压力和心电图变化。结果:所有病例的术中、术后均未出现严重并发症,所有病例均无死亡,随访12个月,36例接受介入封堵+经导管射频消融术28例转复为窦性心律,8例仍为AF,后行二次射频消融术转为窦性心律,84例ASD补术+改良迷宫手术患者中有66例转复窦性,14例失败仍为AF,4例为交界性心律,单纯介入封堵组16例8例成功,8例术后仍为AF,与术前比较,各组心脏超声检查示右心房、右心室内径均较术前明显缩小,肺动脉压力明显下降(均P<0.05)。各组之间无显著差异。经导管射频消融组和改良迷宫手术组AF治愈率高(对比单纯介入组,均P<0.05),患者心慌不适更能得到改善,生活质量更高。结论:介入封堵及外科手术均能安全有效治疗ASD并发AF,每种方法各有利弊,可依据患者临床具体情况选择。

AIM： To introduce treatment strategies and analyze their therapeutic effect for atrial septal defect （ASD） with atrial fibrillation in adult patients. METHODS： One hundred and thirty-six cases of atrial septal defect with significant clinical symptoms and ineffective drug treatment were analyzed. In the radiofrequency catheter ablation （RFA） group were 36 cases who underwent transcatheter closure of ASD and radiofrequency catheter ablation, in the RFA maze group were 84 cases who underwent ASD repair op eration and radiofrequency ablation modified maze procedure with cardiopulmonary bypass, and in simple interventional closure group were 16 cases who underwent only transcatheter closure of ASD and no radiofre- quency catheter ablation. At preoperation and 12 months after operation, results of electrocardiogram and echocardiogram were compared. RESULTS： No serious complications and operative death occurred in the patients under study. In radiofrequency catheter ablation group, 28 patients restored to sinus rhythm after the operation and 8 patient underwent radiofrequency ablation again before restoration to sinus rhythm. In RFA maze group, 66 of the 84 patients restored to sinus rhythm, 14 patients remained atrial fibrillation and 4 patient remained junctional rhythm. In simple interventional closure group, 8 patients restored to sinus rhythm and 8 patients remained atrial fibrillation. Compared with those of preoperation, echocardiography showed that right atrium and right ventricular diameter significantlv reduced in each noun （ all P 〈 0. 05and pulmonary artery pressure significantly decreased （all P 〈 0. 05 ）, with no significant differences between the three groups. The success rates of sinus rhythm in both radiofrequency catheter ablation group and RFA maze group were higher than that in the simple interventional closure group. CONCLUSION： Transcatheter closure and ASD repair operation are effective and safe in treating secundum type ASD. Selection of appropriate treatment strategy for ASD with atrial fibrillation is the key to the success of the operation.