双极射频消融术治疗风湿性心脏病合并心房颤动的对照研究

Bi-polar radiofrequency ablation for rheumatic heart disease with atrial fibrillation

目的评价风湿性心脏病合并心房颤动(房颤)患者瓣膜手术同期行双极射频消融的临床疗效和患者术后生活质量。方法纳入2014年7月至2015年5月我院心脏大血管外科风湿性心脏病患者96例,合并房颤74例,22例为窦性心律。根据手术方式将96例患者分为3组:试验组(瓣膜置换+射频消融)40例、对照组(瓣膜置换)34例、空白组(窦性心律者行瓣膜置换)22例。分析患者临床效果及生活质量。结果试验组患者出院时窦性心律转复率、随访期间窦性心律维持率、随访末期左房前后径(LAD)的缩小幅度及肺动脉收缩压(PASP)的降低幅度高于对照组,患者死亡率、不良事件发生率未增加。在术后3个月、6个月时,试验组在SF-36量表6个维度及躯体健康评分(PCS)、精神健康评分(MCS)、总分得分高于对照组,术后12个月时在生理功能(PF)、生理职能(RP)、总体健康(GH)3个维度及躯体健康评分(PCS)、总分得分高于对照组。结论房颤会加重风湿性心脏病患者心脏结构的异常改变,双极射频消融有利于房颤患者术后窦性心律的恢复与维持、明显缩小LAD,降低PASP。对风湿性心脏病合并房颤患者,瓣膜手术同期行双极射频消融术能提高患者生活质量。

Objective To evaluate the clinical effects of bi-polar radiofrequency ablation （BRFA） for the surgical treatment of atrial fibrillation （AF） in rheumatic heart disease （RHD） patients. Methods We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed. Results Left atrial diameter （LAD）, pulmonary arterial systolic pressure （PASP）, and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significandy higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning （PF）, role-physical （RP）, general health （GH）, vitality （VT）, social functioning （SF）, mental health （MH）, physical component summary （PCS）, mental component summary（MCS） and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group. Conclusion AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD ＆ PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.