合并房颤者的非体外循环冠状动脉旁路移植同期心外膜射频消融治疗

The effect of novel modified radiofrequency ablation for preoperative atrial fibrillation combined with off-pump coronary artery bypass grafting surgery

目的评价在非体外循环冠状动脉旁路移植术同期行心外膜射频消融治疗冠心病合并房颤的临床疗效。方法2007年1月至2014年1月间，49例患者行同期非体外循环冠状动脉旁路移植和心外膜房颤射频消融术，男29例，女20例；年龄48～74岁，平均（64．3±14．1）岁。术前阵发性房颤11例，持续性房颤19例，永久性房颤19例。术后随访（37．9±18．1）个月。复查24h动态心电图及超声心动图，观察患者心律及心脏功能变化情况。结果全组无围手术期死亡，无术后严重低心排血量综合征，无置入永久起搏器病例。射频消融（33．2±5．2）min，冠状动脉旁路移植手术（90．3±16．6）min，ICU滞留（4．7±2．5）天，术后住院（14．5±6.1）天。出院时46例（93．9％）恢复窦性心律，术后1年41例（83．7％）维持窦性心律。超声心动图结果示左心房内径较术前明显缩小，左心室射血分数较术前明显增加。结论对于冠心病合并房颤的患者，心外膜房颤射频消融术可与非体外循环冠状动脉旁路移植术同期进行，是具有良好安全性及临床疗效的手术方式。

Objective To evaluate the effect of novel modified bipolar radiofrequency（RF） ablation for preoperative atrial fibrillation（AF） combined with off-pump coronary artery bypass grafting（OPCABG） for patients with AF and coronary artery disease（CAD）. Methods From January 2007 to January 2014,49 patients with AF, and CAD underwent the novel modified bipolar RF ablation combined with OPCABG in our department, 29 males and 20 females（ 11 paroxysmal, 19 persistent and 19 long-standing persistent） . The patients were followed up with 24 hours Hoher monitoring and echocardiography for （ 37.89 ± 18.1 ） months after the procedure. Results There were no perioperative death, serve low cardiac output syndrome or permanent pacemaker implantation. Mean AF ablation time was （ 33.2 ± 5.2） rain, and the mean OPCABG time was （90.3 ± 16.6 ） min. Mean ICU stay time was （4.7 ± 2.5 ） days, and mean postoperative time was （ 14.5 ±6.1 ） days. The maintenance of sinus rhythm was 93.9% （46/49） at discharge, while the rate was 83.7% （41/49） one year later. Follow-up echo- cardiography data at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. Conclusion The novel modified bipolar RF ablation combined with OPCABG proce- dure was safe, feasible and effective. It may be useful in selecting the best ablation approaches for patients with AF and CAD.