外科心房颤动射频消融的两种术式近期结果比较

Comparison of short-term outcomes of radiofrequency ablation for atrial fibrillation with two kinds of procedures

目的采用前瞻性研究比较心脏瓣膜手术同期行心房颤动（房颤）射频消融的两种不同术式的治疗效果．为外科房颤射频消融的术式选择提供参考。方法选取2015年1月至2015年6月在广东省人民医院入院诊断为风湿性心脏瓣膜病同时并发房颤的患者73例，按随机数字表法随机分成两组：左心房加简化右心房消融组29例，左、右心房双心房消融组44例。比较两组患者的一般临床资料、消融时间、体外循环（CPB）时间、重症监护病房留观时间、呼吸机辅助时间、术后窦性心律恢复情况及随访结果。结果所有患者顺利完成手术，无围术期死亡。房颤发生时间在左心房加简化右心房消融组为（43．52±43．32）个月，双心房消融组为（32．02±38．74）个月，两组之间比较差异无统计学意义（P〈0．05）。左心房加简化右心房消融组行双瓣置换11例。二尖瓣置换17例，主动脉瓣置换1例；双房消融组行双瓣置换8例，二尖瓣置换36例；两组之间瓣膜术式比较，差异有统计学意义（P=0．04）。左心房加简化右心房组与双心房组消融时间[（32．09±7．62）min vs（34．24±8．34）min，P=0．319]、体外循环时间[（155．13±32．00）minUS．（144．42±37．64）min，P=0．264]、重症监护病房留观时间[（76．48±119．47）hVS．（70．20±77．66）h，P=0．786]、呼吸机辅助时间[（23．95±22．29）h vs（25．23±27．96）h，P=0．837]比较，差异无统计学意义。出院时左心房加简化右心房消融组的转窦成功率为62．1％，标准双心房消融组的成功率为72．7％，两组比较，差异无统计学意义（x2=0．841，P=0．718）。术后3个月随访两组患者的转窦成功率，左心房加简化右心房消融组69．0％，双心房消融组76．2％，差异无统计学意义（X2=0．457，P=0．499）。结论左心房加简化右心房消融与标准双心房消融有相似的窦性心律恢复率，而简化右心房消融减少了消融线数量，简化了操作，缩短了消融时间。

Objectives To compare the treatment effects of two different ways of atrial fibrillation ablation with cardiac valvular surgery over the same period, providing a procedural reference for radiofrequency ablation for atrial fibrillation. Methods Seventy-three cases with rheumatic heart disease combined with atrial fibrillation at admission from January 2015 to June 2015 in Guangdong General Hospital were randomly divided into two groups： left atrial ablation ＋ simplified right atrial ablation group （n=29） and left and right atrial ablation group （n=44）. General clinical data, ablation durations, duration of cardiopulmonary bypass （CPB）, duration of intensive care unit （ICU） stay, time on auxiliary breathing machine, sinus rhythm recovery rate and postoperative follow-up results were compared between the two groups. Results All the patients received successful surgery with no perioperative death. Duration of atrial fibrillation in left atrial ablation＋simplified right atrial ablation group was （43.52±43.32） months, in left and right atrial ablation group was （32.02＋38.74） months; there was no statistical difference between the two groups （P〈0.05）. Left atrial ablation＋simplified right atrial ablation group processed double valve replacement in 11 cases, mitral valve replacement in 17 cases and aortic valve replacement in 1 case; left and right atrial ablation group had 8 cases of double valve replacement and 36 cases of mitral valve replacement; there were significant differences between the two groups （P=0.04）. There were no significant differences in durations of ablation [ （32.09±7.62） rain vs. （34.24±8.34） rain, P=0.3191, cardiopulmonary bypass [ （155.13±32.00） min vs. （144.42±37.64） min, P=0.264], ICU stay [ （76.48±119.47） h vs. （70.20±77.66） h, P=0.786] and ventilation [（23.95±22.29） h vs. （25.23±27.96） h, P=0.837] between left atrial ablation＋simplified right atrial ablation group and left and right atrial ablation group. Sinus rhythm recovery rates of left atrial ablation＋simplified right atrial ablation group and left and right atrial ablation group were 62.1% and 72.7% at discharge; there was no significant difference between the two groups （A~=0.841 ,P=0.718）. After 3 months＇ follow-up, the success rates of left atrial ablation＋simplified fight atrial ablation group and left and fight atrial ablation group were 69.0% and 76.2%; there was no significant difference （X2=0.457 ,P=0.499）. Conclusions Left atrial ablation＋simplified right atrial ablation has a similar sinus rhythm recovery rate with standard left and fight atrial ablation, but the former reducs the number of linear lesion, simplifies the operation and shortens the operation duration.