Objective To study the radiofrequency ablation (RA) and vagal denervafion (VD) in surgical treatment of long-standing atrial fibrillation (AF) associated with rheumatic heart disease (RHD).Methods Retrospective analysis the cardiac rhythm by 24-hour Holter monitoring during 5-year follow-up after total Maze procedure accompanied rheumatic mitral valve replacement.Between June 2006 and December 2007,a total of 173 consecutive patients with long-standing AF-associated RHD underwent mitral valve replacement and ablation maze procedure,92 cases had RA alone and 81 had RA + VD.Results Although Kaplan-Meier curve shows that the freedom from AF at 5 years follow-up time were similar(P =0.718),the percentage of antiarrhythmic drug therapy was significant higher in the RA group during early postoperative period(4th month,54.1％ vs.34.7％,P=0.017;5th month,39.2％ vs.21.3％,P=0.018;6th month,23.0％ vs.10.7％,P =0.044),and the percentage of those free by AF was significant lower(6th month,82.2％ vs.93.8％,P =0.023;1st year,76.1％ vs.89.9％,P=0.019).Conclusion Total maze procedure with bipolar radiofrequency ablation is effective to treat longstanding AF associated with rheumatic valve disease.Vagal denervation helped to maintain stable sinus rhythm and lower antiarrhythmic drug therapy at the early stage,but there was no additional benefit after the 1 st year of follow-up,it may be caused from the reactivation of vagal plexus electrical activity.%目的 探讨去自主神经化(VD)在全迷宫外科射频消融手术(RA)治疗风湿性心脏瓣膜病伴发持续性房颤的中期治疗效果.方法 应用动态心电图等手段,回顾性分析2006年6月至2007年12月期间173例风湿性心脏瓣膜病单纯二尖瓣手术,同期行射频消融及去自主神经化治疗伴发性房颤患者的术后5年心律变化情况.按照手术方式分为RA组92例,RA+ VD组81例.结果 Kaplan-Meier生存曲线分析显示术后5年两组房颤免除率无显著差别(P=0.718).RA组和RA+ VD组术后第4、5、6个月抗心律失常药物应用比例分别为54.1％/34.7％ (P =0.017)、39.2％/21.3％ (P =0.018)、23.0％/10.7％ (P =0.044);房颤免除率术后6个月为82.2％/93.8％(尸=0.023),术后第1、2、3、4、5年分别为76.1％/89.9％(P=0.019)、73.6％/77.2％(P=0.586)、70.9％/73.1％ (P=0.760)、69.4％/70.1％ (P =0.921)、66.7％/68.4％ (P =0.813).结论 应用射频消融手术治疗风湿性心脏瓣膜病伴发持续性房颤中期效果良好.去自主神经化可在术后1年内有效降低抗心律失常药物应用率及房颤复发率,但1年后该效果逐渐消失,可能与迷走神经丛电活动复发有关.
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