上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (1): 85-.doi: 10.3969/j.issn.1674-8115.2012.01.017

• 论著（临床研究） • 上一篇    下一篇

改良迷宫射频消融治疗心房纤颤的临床研究

曾颖鸥, 张 卫, 叶 伟, 石 暐   

  1. 上海交通大学附属胸科医院心血管外科, 上海 200030
  • 出版日期:2012-01-28 发布日期:2012-01-29
  • 通讯作者: 张 卫, 电子信箱: zhangwyyy@citiz.net。
  • 作者简介:曾颖鸥 （1979—）, 男, 硕士, 主治医师, 现在上海交通大学附属第六人民医院奉贤分院心胸外科工作（201400）；电子信箱: zengyingou@163.com。

Clinical study of atrial fibrillation treated by radiofrequency ablation modified maze procedure

ZENG Ying-ou, ZHANG Wei, YE Wei, SHI Wei   

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2012-01-28 Published:2012-01-29

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摘要：

目的 通过总结心脏直视手术同期行心房纤颤（房颤）射频消融术的疗效，分析影响疗效的因素。方法 对161例伴有房颤的心外科患者手术同期以Cox's Maze Ⅲ为基础，其中轻度三尖瓣病变患者行单纯左心房消融（单房消融组，n=27），中重度三尖瓣病变患者行双房消融（双房消融组，n=134），分析两组消融成功率和术后并发症以及影响术后窦性心律恢复的因素。结果 所有的患者术后均得到随访，平均随访时间为（24.64±12.92）月。术后即刻心电监护显示：69.57%的患者恢复窦性心律，14.91%为结性心律；出院时75.78%的患者恢复窦性心律；术后6个月时81.37%的患者恢复窦性心律。单房消融组的窦性心律恢复率为77.78%，双房消融组为82.09%，两组差异无统计学意义（P>0.05）。多因素分析显示：心功能分级、术后射血分数、体外循环时间和主动脉阻断时间是术后影响能否转为窦性心律的主要因素（P<0.05）。结论 轻度三尖瓣病变的房颤患者采用单纯左心房消融，中重度三尖瓣病变患者采用双房消融，两者疗效相当。术前心功能分级、术中体外循环时间和主动脉阻断时间、术后射血分数是消融术后预测能否恢复窦性心律的主要因素。

关键词: 射频消融, 房颤, 改良迷宫术

Abstract:

Objective To investigate the outcomes of radiofrequency ablation modified maze procedure during open-heart surgery for patients with atrial fibrillation, and analyse the factors influencing the efficacy. Methods One hundred and sixty-one patients with atrial fibrillation undergoing cardiovascular surgery were treated on the basis of modified Cox's Maze Ⅲ. Twenty-seven patients with mild tricuspid valve disease were treated with simple left atrial ablation (single room ablation group), and 134 patients with moderate to severe tricuspid valve disease underwent double room ablation (double room ablation group). The success rate of ablation, postoperative complications, and impact factors for postoperative recovery of sinus rhythm were analysed in two groups. Results All patients were followed up for an average of (24.64±12.92) months after surgery. Electrocardiographic monitoring indicated that sinus rhythm was recovered in 69.57% of patients immediately after surgery, and 14.91% of patients had nodal rhythm. The percentages of patients with sinus rhythm were 75.78% and 81.37% at discharge and 6 months after operation respectively. The recovery rate of sinus rhythm in single room ablation group was 77.78%, and that in double room ablation group was 82.09%, and there was no significant difference between two groups (P>0.05). Multivariate analysis revealed that cardiac function classification, ejection fraction after surgery, time of cardiopulmonary bypass and time of aortic cross-clamping were main factors affecting recovery of sinus rhythm (P<0.05). Conclusion Atrial fibrillation with mild tricuspid valve disease should be treated with simple left atrial ablation, atrial fibrillation with moderate to severe tricuspid valve disease should be managed with double atrial ablation, and both may yield similar outcomes. Cardiac function classification before surgery, ejection fraction after surgery, time of cardiopulmonary bypass and time of aortic cross-clamping are the main predictors for recovery of sinus rhythm after ablation.

Key words: radiofrequency ablation, atrial fibrillation, modified maze procedure