新型改良心外射频消融术治疗主动脉瓣病变合并心房颤动的疗效分析

Novel Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined with Aortic Valve Disease

目的探讨新型改良心外射频消融术在主动脉瓣置换术中的应用,分析其对主动脉瓣病变合并心房颤动(房颤)的治疗效果。方法回顾性分析2009~2014年我院应用新型改良心外射频消融术在单纯主动脉瓣置换术中同期治疗主动脉瓣病变合并房颤28例患者的临床资料,其中男18例、女10例,年龄53~73(64.9±4.8)岁。术中先行新型改良心外房颤射频消融术,再行主动脉瓣置换术。结果所有患者均顺利完成新型改良心外射频消融术及主动脉瓣置换术。围术期无死亡,无起搏器植入。3例患者术后住院期间行电复律治疗,27例(27/28,96.4%)患者出院时维持窦性心律。术后6个月复查经胸超声心动图提示左心房直径较术前明显减小,左心室射血分数较术前明显升高(P<0.001)。随访4~64(29.2±17.7)个月,无远期死亡,26例(26/28,92.9%)患者维持窦性心律。结论新型改良心外射频消融术治疗主动脉瓣病变合并房颤是一种安全、有效、简便的方法,近、远期效果良好,值得推广应用。

Objective To assess the effect of a novel modified epicardial radiofrequency(RF) ablation for preoperative atrial fibrillation(AF) combined with aortic valve disease.Methods We retrospectively analyzed the clinical data of 28 patients with AF and aortic valve disease underwent the novel modified epicardial RF ablation combined with aortic valve replacement(AVR) in our hospital between December 2009 and December 2014.There were 18 males and 10 females at age of 53-73(64.9±4.8) years.The patients were performed epicardial atrial fibrillation RF ablation plus aortic valve replacement.Results The modified epicardial RF ablation and AVR were performed successfully in all the patients.The maintenance of sinus rhythm was 96.4%(27/28) at discharge.There were no early death and permanent pacemaker implantation in perioperation.At a mean following-up of 29.2±17.7 months,26 of 28(92.9%) patients were in sinus rhythm.Following-up transthoracic echocardiography(TTE) at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased.Conclusion The novel modified epicardial RF ablation procedure is safe,feasible,and effective.It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.