心脏瓣膜置换同期行双极射频消融术治疗房颤的临床疗效

摘要

目的：探讨心脏瓣膜置换同期行双极射频消融术（BRFA）治疗心房纤颤（AF）的临床疗效及安全性。方法回顾性分析2011年1月至2012年12月在瓣膜置换术同期行BRFA治疗的90例A F患者临床资料，患者在全身麻醉开胸直视体外循环下行瓣膜置换术及BRFA。术后随访患者心脏彩色超声、心电图等指标，分析比较其疗效。结果患者动脉阻断时间为65～120 min ，平均（75．5±24．5）min ，体外循环时间为45～200 min ，平均（112．5±30．8）min；BRFA时间为13～28 min ，平均（21．5±7．5）min。随访结果表明91．11％患者术后3个月维持窦性心律，术后12个月左心房、左心室径线较术前明显减小，左心室射血分数较术前明显增高，差异有统计学意义（P＜0．05）；同时房颤持续时间、术前左房径线及左室径线对手术成功有影响。结论心脏瓣膜置换术同期行BRFA治疗AF安全、简便且效果良好，值得临床推广应用。%Objective To explore effect and safety of bipolar radiofrequency ablation (BRFA ) for atrial fibril‐lation (AF) in the course of heart valve replacement surgery .Methods Retrospectively ananlyze the clinical data of 90 cases of heumatic heart disease with AF received BRFA for AF in the course of heart valve replacement surgery from January 2011 to December 2012 .The efficacy were analyzed and compared by the indicators of cardiac color ul‐trasound ,eletrocardiogram(ECG) and others .Results The artery occlusion time was 65 -120(75 .5 ± 24 .5) min , cardiopulmonary bypass time was 45-200(112 .5 ± 30 .8)min ,BRFA time was 13-28(21 .5 ± 7 .5)min .The results of follow‐up showed after operation 3 months ,91 .11% AF patients maintained sinus rhythm ,and postoperative left atrium ,left ventricular diameter was significantly decreased ,left ventricular ejection fraction was significantly higher than preoperation(P<0 .05) .There were some factors such as the duration of AF ,preoperative left atrial diameter and left ventricular diameter ,which affected the operation success .Conclusion The treatment of bipolar radiofre‐quency ablation (BRFA)for atrial fibrillation(AF)in the course of heart valve replacement surgery could receive a sat‐isfactory outcome with few complications ,safe and reliable and it is worthy to be popularized .