射频消融迷宫手术在瓣膜病并发心房颤动中的应用

Efficacy of radiofrequency ablation in patients with valvular heart disease complicated by atrial fibrillation during valve surgery

目的分析心脏瓣膜病并发心房颤动(房颤)的患者外科手术同时行射频消融迷宫手术的疗效,探讨外科手术治疗瓣膜病并发房颤的临床价值。方法筛选2010年1月至2013年1月收治的瓣膜病并发房颤住院患者40例,在心内直视手术的同时行射频消融迷宫手术,观察随访术后1年患者恢复窦性心律比例。结果 40例住院手术的患者中,手术后即刻房颤全部消失,出院时窦性心律29例(72.5%),结性心律9例(22.5%),Ⅰ度房室传导阻滞1例(2.5%),Ⅲ度房室传导阻滞1例(2.5%)。随访1年后窦律27例(67.5%),结性心律3例(7.5%),心房扑动2例(5%),房颤7例(17.5%),Ⅲ度房室传导阻滞1例(2.5%),安置永久起搏器。其中29例恢复窦性心律,转复率为67.5%。结论心脏瓣膜病并发房颤的患者在心脏外科手术的同时行射频消融术,对窦律的恢复是一种安全有效的方法,手术安全性高,远期疗效确切。

Objectives To evaluate the efficacy of radiofrequeney ablation in patients with valvular heart disease complicated by atrial fibrillation who underwent surgical operation, and to explore the clinical application of surgical treatment for atrial fibrillation in patients with heart valve disease. Methods Data were collected as a part of prospective registry of valve surgery through January 2010 to January 2013. All the 40 cases with valvular heart disease complicated by atrial fibrillation underwent radiofrequency ablation with concomitant open-heart surgery. All the patients were followed up for one year. Results There was no atrial fibrillation in the 40 cases immediately after procedure. At the time of discharge, there were 29 （72.5%） patients with sinus rhythm, 9 （22.5%） with junctional rhythm, 1 （2.5%） with I° atrioventricular block and 1 （2.5%） with Ⅲ° atrioventrieular block. After one year＇s follow-up, there were 27 （67.5 % ） patients with sinus rhythm, 3 （7.5%） with junctional rhythm, 2 （ 5% ） with auricular flutter, 7 （ 17.5% ） with atrial fibrillation and 1 （2.5%） with Ⅲ° atrioventricular block. Conclusions Radiofrequency ablation with concomitant open-heart surgery is a safe and effective technique to recover sinus rhythm for patients with valvular heart diseases and atrial fibrillation. The long-term outcome is satisfactory.