老年心房颤动患者行单极和双极射频消融的疗效比较

Therapeutic effect comparison between unipolar and bipolar radiofrequency ablation in treating atrial fibrillation in elderly patients

目的 探讨65岁以上患者行单极与双极射频消融治疗心房颤动的临床疗效和影响因素. 方法 选取我院心外科2008年10月至2013年12月50例器质性心脏病合并心房颤动的老年患者,根据手术方式分为单极射频消融组20例（单极组）和双级射频消融组30例（双极组）.术后随访3个月、6个月、12个月,记录心电图,观察窦性心律的转复情况.根据心电图结果,将术后12个月随访患者（43例）分为窦性与非窦性心律组,比较两组相关因素的差异. 结果 术后3个月、6个月、12个月窦性心律转复率单极组分别为73.7％（14/19）、66.7％（12/18）、61.1％（11/18）,双极组分别为82.8％（24/29）、85.2％（23/27）、88.0％（22/25）.两组术后12个月转复率比较,差异有统计学意义（P＜0.05）.并发症单极组为55.0％（11例）,双极组为26.7％（8例）,两组比较差异有统计学意义（P＜0.05）.术前心房颤动病史、左心房内径是影响窦性心律转复率的因素（P＜0.05）. 结论 双极射频消融治疗心房颤动安全性高、并发症少、成功率高.术前心房颤动病史长和左心房大的患者转复率低,且易复发.

Objective To compare clinical effect of unipolar versus bipolar radiofrequency ablation in treating atrial fibrillation （AF） in elderly patients and discuss the correlated risk factors.Methods From October 2008 to December 2013,a total of 50 elderly patients with organic heart disease and AF underwent radiofrequency ablation surgery.All patients were divided into 2 groups of unipolar （group A,n=20） and bipolar （group B,n=30 patients） radiofrequency ablations.The variations of electrocardiogram （ECG） and ultrasonic cardiogram （UCG） in patients were collected and the complications and the NYHA class of the patients were recorded at 3,6 and 12 months after surgery.The total 43 elderly patients were divided into sinus group and non-sinus group according to their ECG at 12 months after surgery.Results The recovery rates of sinus rhythm at 3,6 and 12 months after surgery were 73.7％（14/19）,66.7％（12/18） and 61.1％ （11/18）respectively in group A and 82.8％（24/29）,85.2％（23/27）and 88.0％（22/25） respectively in group B.Two groups of the recovery rate of sinus rhythm had a statistically significant difference between the two groups （P＜0.05） at 12 months after surgery.The complication rate in group A was higher than in group B [55.0％ （11 cases） vs.26.7％ （8 cases）,P＜0.05].Preoperative history of AF and left atrial diameter were the influencing factors for the sinus rhythm recovery rates （P＜0.05）.Conclusions Bipolar radiofrequency ablation for AF is safe and has less complications and high success rate of restoring sinus rhythm.The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm with a high recurrence rate.