心脏直视手术下行仿改良迷宫Ⅲ术射频消融治疗心房颤动

目的 评价心脏直视下行盐水冲洗射频消融仿改良迷宫Ⅲ手术(IRFMM)治疗心脏瓣膜病合并心房颤动(房颤)的安全性及有效性.方法 回顾分析63例心脏瓣膜病合并持续性房颤病例,其中31例行瓣膜置换同期行IRFMM手术治疗房颤(治疗组),32例行瓣膜置换而未同期行IRFMM术(对照组)的治疗结果和早期随访资料.结果 治疗组18例术后立即恢复窦性心律,3例术后使用临时起搏器,于术后5 d内恢复窦性心律,7例术后由交界区心律转为窦性心律,3例仍为房颤.术后随访2～19个月,出院时90.3%(28/31)为窦性心律,随访半年以上91.3%(21/23)维持窦性心律,随访1年以上85.7%(12/14)维持窦性心律.对照组术后仅3例短暂转复为窦性心律,出院时全转为房颤.32例随访2～19个月,未转为窦性心律者,两组相比差异有统计学意义(P＜0.01).结论 使用美敦力公司Cardioblate盐水冲洗射频消融系统代替切割、冷冻施行迷宫术治疗房颤安全简便有效.

The treatment of atrial fibrillation with saline-irrigated radiofrequency modified maze Ⅲ procedure in open heart surgery

Objective To evaluate the safety and efficacy of saline-irrigated radiofrequency modified maze Ⅲ procedure (IRFMM) for patients suffering from valve diseases combined with atrial fibrillation in open heart surgery. Methods The short-term results were retrospectively analyzed in 31 patients who accepted valve replacement and IRFMM procedure. Thirty-two patients treated with valve replacement without ablation served as control group. Results In treated group, eighteen cases resumed sinus rhythm immediately after the surgery.Three cases used temporary pacemaker after the operation, and resumed sinus rhythm within five days. Seven patients resumed sinus rhythm from nodal rhythm postoperatively, three cases remained atrial fibrillation. The follow-up time varied from 2 to 19 months. 90. 3% (28/31) of patients restored sinus rhythm when they were discharged. Six months after operation, 91.3% (21/23)of patients restored sinus rhythm. One year after operation, 85.7% (12/14)of patients restored sinus rhythm. In control group, only three cases of the patients resumed sinus rhythm temporary and returned to atrial fibrillation when discharged. At a follow-up of 2 ～ 19months, none resumed sinus rhythm. Difference was significant. Conclusion The radiofrequency ablation technique of Medtronic cardioblate system is safer and easier to use than the traditional excising technique and can also achieve the same satisfied clinical results.