心脏手术同期射频消融治疗心房颤动合并低左心室射血分数的患者中期疗效临床研究

Mid-term Efficacy of Radiofrequency Ablation in Patients with Atrial Fibrillation and Low Left Ventricular Ejection Fraction during Cardiac Surgery

目的探讨对心房颤动(atrial fibrillation,AF)合并低左心室射血分数(left ventricular ejection fraction,LVEF)的患者在心脏手术同期行射频消融治疗的中期疗效,评价射频消融治疗的安全性和有效性。方法2004年1月至2019年1月,在广东省人民医院进行心脏手术同期射频消融治疗的患者中,共54例术前AF合并低LVEF的患者(随访资料完整),其中男29例,女25例;年龄范围为26~71岁;AF病史为(6.8±3.7)年;根据12个月随访期后是否恢复窦性心律(sinus rhythm,SR)为依据,将其分为SR组和AF组。其中SR组31例,AF组23例。手术方式:心脏手术同期双极射频消融,进行双心房消融。结果全组患者院内及12个月随访期内均无死亡。随访12个月,SR组LVEF(58.38%±8.95%)高于AF组LVEF(52.49%±11.40%),差异有统计学意义(P<0.05);SR组LVEF(58.38%±8.95%)和AF组LVEF(52.49%±11.40%)分别均较术前(41.72%±4.50%)和(42.53%±7.20%)明显提高,差异有统计学意义(P<0.05);SR组左心室舒张末期直径[(47.13±7.88)mm]和AF组[(49.03±7.13)mm],分别均较术前[(52.23±9.07)mm和(54.41±9.25)mm]明显缩小,差异有统计学意义(P<0.05);SR组左心房直径:[(44.03±6.69)mm]和AF组[(943.00±6.55)mm],分别均较术前[(50.59±7.57)mm和(52.34±7.57)mm]明显缩小,差异有统计学意义(P<0.05)。结论心脏手术同期射频消融治疗AF合并LVEF的患者是安全的治疗方法,术后恢复SR能明显提高患者的LVEF,对心功能改善的中期疗效更佳。

Objectives To evaluate the mid-term efficacy of radiofrequency ablation in patients with atrial fibrillation(AF)and low left ventricular ejection fraction(LVEF)during cardiac surgery,and to evaluate the safety and effectiveness of radiofrequency ablation.Methods From January 2004 to January 2019,there were 54 patients with AF and LVEF<50%underwent cardiac surgery and radiofrequency ablation in Guangdong Provincial People′s Hospital.50%of the patients had intact follow-up data,including 29 males and 25 females.The age ranged from 26 to 71 years old.The average history of AF was(6.8±3.7)years.The patients were divided into sinus rhythm(SR)group and AF group according to whether SR was regained after 12 months of follow-up.There were 31 cases in SR group and 23 cases in AF group.Surgical methods:All the patients underwent bipolar radiofrequency ablation during the cardiac surgery.Results There was no death in the whole group of patients in the hospital and during the follow-up period of more than 12 months.LVEF in SR group(58.38%±8.95%)was significantly higher than that in AF group(52.49%±11.40%)(P<0.05).LVEF in SR group(58.38%±8.95%)and AF group(52.49%±11.40%)were significantly higher compared with preoperative(41.72%±4.50%)and(42.53%±7.20%)(P<0.05).The left ventricular end-diastolic diameter in SR group[(47.13±7.88)mm]and AF group[(49.03±7.13)mm]were significantly smaller than those before operation[(52.23±9.07)mm and(54.41±9.25)mm](P<0.05).Compared to the preoperative[(50.59±7.57)mm and(52.34±7.57)mm],the left atrial diameter in SR group[(44.03±6.69)mm]and AF group[(43.00±6.55)mm]were significantly smaller(P<0.05).Conclusions Cardiac surgery combined with radiofrequency ablation is a safe and effective treatment for patients with AF and low LVEF.The recovery of SR after surgery can significantly improve the LVEF of patients,which mid-term effect of cardiac function improvement is better.