射频消融结合局部冷冻治疗瓣膜病合并长程持续性房颤的远期效果分析

Long-term outcomes for surgical treatment of long-standing persistent atrial fibrillation using bipolar radiofrequency ablation during concomitant cardiac valve procedures

目的:探讨双极射频消融(bipolar radiofrequency ablation,BRA)在治疗瓣膜病合并长程持续性房颤(long-standing persistent atrial fibrillation,LSP-AF)的远期效果。方法:回顾性分析2007年1月至2010年12月268例瓣膜病合并LSP-AF,在心脏手术同时行BRA手术患者。比较患者术后窦性心律转复及房颤复发情况等,以及影响远期疗效的危险因素。结果:268例患者中行单纯二尖瓣手术86例,单纯主动脉瓣手术4例,联合瓣膜手术164例,其他类型手术9例。术前房颤病程(2.00±1.89)年,左心房直径(56.83±8.27)mm,术后30天内死亡15例。术后随访窦性心律维持率1年86.6%,2年75.4%,5年67.7%,8年57.8%。Cox多因素回归分析显示左心房直径(HR=1.073,P<0.001)和房颤病程(HR=1.070,P=0.025)为房颤复发的独立危险因素。结论:瓣膜手术同期应用双极射频消融治疗长程持续性房颤,采用双房全迷宫消融线路,并发症少,安全简便且远期效果良好。

Objective To evaluate the long-term results of bipolar radiofrequency(BRF)ablation in restoring sinus rhythm in patients with permanent atrial fibrillation(AF)undergoing surgery for cardiac surgery.Methods This retrospective study sample consisted of 268 patients with LSP-AF underwent cardiac operations concomitant BRF mazeⅣprocedure.Data were collected prospectively on perioperative outcomes,rhythm status,survival,and clinical events.Results 15 patients died in the early postoperative period,perioperative mortality rate was 5.5%.The rate of stable sinus rhythm(sSR)was 86.6%,75.4%,67.7%,57.8% in 1,2,5,8 years after operation.Multivariate analysis proved the size of the left atrium(HR=1.073,P<0.001)and duration of AF(HR=1.070,P=0.025)to be an independent predictor of the radiofrequency ablation outcome.Conclusion Bipolar radiofrequency maze procedure can effectively eliminate AF,maintain long-term of sinus rhythm.Bipolar radiofrequency maze procedure is a safe,easy and effective surgical option for the treatment of AF,with satisfactory long-term results,is worthy of promotion.