风湿性心脏瓣膜病并发心房颤动患者单极和双极射频消融的疗效对比

Comparison of the efficacy in patients with rheumatic heart valve disease complicated with atrial fibrillation treated by monopole and bipolar radiofrequency ablation

目的了解单极或双极射频消融技术应用于风湿性心脏瓣膜病并发心房颤动患者治疗的临床疗效差异,为采取针对性治疗措施提供理论支持。方法 2012年11月至2017年6月期间,对北京大学深圳医院收治的80例风湿性心脏瓣膜病并发心房颤动患者进行了临床研究,均分为对照组(单极射频消融)和实验组(双极射频消融),比较两组治疗前后(术前、出院时、出院后3个月、出院后6个月)超声功能参数(包括左心房横径、左心室收缩末期横径、左心室舒张末期横径、左心室射血分数),心房颤动发病率及即刻心率情况(即刻心率包括窦性心率不齐、心房扑动、交界心律),心功能分级,围术期并发症(包括再开胸止血、顽固低心排血量综合征、心律失常、主动脉内球囊反搏(IABP)使用、传导阻滞、肺部感染等)的统计学差异。结果两组不同治疗时点左心房横径、左心室收缩末期横径、左心室舒张末期横径、左心室射血分数比较,差异均有统计学意义(均有P<0.05)。两组治疗出院3、6个月后左心室收缩末期横径、左心室舒张末期横径比较,差异均有统计学意义(P<0.05)。两组手术前后心房颤动发病率比较,差异均有统计学意义(P<0.05)。两组手术前后即刻心率情况指标中窦性心律不齐、交界心律的比较,差异均有统计学意义(P<0.05)。两组出院后6个月心功能分级的比较,差异有统计学意义(P<0.05)。两组围术期并发症指标中主动脉内球囊反搏使用情况比较,差异有统计学意义(P<0.05)。结论无论单极还是双极射频消融治疗技术,对于风湿性心脏瓣膜病并发心房颤动患者的心功能均有积极治疗和促进作用,同时双极射频消融治疗技术相对而言,更能降低患者心房颤动发病率、恢复正常的窦性心律,手术后并发症发病率也相对更低。

Objectives To understand the difference in clinical efficacy of unipolar or bipolar radiofrequency ablation in treatment of patients with rheumatic heart valvular disease complicated with atrial fibrillation and to provide theoretical support for targeted treatment. Methods From November 2012 to June 2016 in Peking University Shenzhen Hospital, 80 patients with rheumatic heart valve disease complicated with atrial fibrillation were divided into control group （unipolar radiofrequency ablation） and experimental group （bipolar radiofrequency ablation）. Before and after treatment （preoperative, discharge and 3 months, 6 months after hospital discharge） ultrasonic function parameters （including left atrial diameter, left ventricular end systolic diameter and left ventricular end diastolic diameter, left ventricular ejection fraction） , atrial fibrillation and heart rate situation （instant heart rate including sinus arrhythnlia, atrial flutter,junctional rhythm） , heart function grading, perioperative complications （including reopen thoracotomy to stop bleed- ing, refractory low cardiac output syndrome, intra aortic balloon pumping usage, heart block, pulmonary infection, etc.） were compared between the two groups. Results There were statistically significant differences of left atrial diameter, left ventricular end systolic diameter, left ventricular end diastolic diameter and left ventricular ejection fraction between the two groups in different treatment time point （P〈0.05）. Differences of left ventricular end systolic diameter and left ventricular end diastolic diameter between the two groups 3 or 6 months after treatment were statistically significant （P〈0.05）. Differences of atrial fibrillation situation between the two groups before and after treatment were statistically significant （ P〈0.05 ）. Differences of sinus arrhythmia and junctional rhythm between the two groups before and after treatment were statistically significant （P〈0.05）. Difference of heart function grading between the two groups 6 months after hospital discharge was statistically significant （P〈0.05）. Difference of intra aortic balloon pumping usage between the two groups was statistically significant （P〈0.05）. Conclusions Both unipolar and bipolar radiofrequency ablation can actively treat and promote heart function of patients with rheumatic heart valve disease complicated with atrial fibrillation. Bipolar radiofrequency ablation can reduce incidence of atrial fibrillation and return to normal sinus rhythm better than unipolar radiofrequency ablation with lower incidence of complications after surgery.