导管射频消融治疗阵发性心房颤动两种术式疗效对比

目的比较节段性肺静脉电隔离术（SPVI）和环肺静脉前庭电隔离术（CPVA）对阵发性心房颤动射频消融治疗的临床疗效。方法选取68例行导管射频消融治疗的阵发性心房颤动患者,根据所采用的术式分为SPVI组（30例）和CPVA组（38例）,比较两组手术时间、X线暴露时间及复发率。结果CPVA组手术时间为（171．0±25．8）min,SPVI组为（168．2±21．7）min,两组比较差异无统计学意义（P：0．579）。CPVA组x线暴露时间为（38．5±8．4）min,SPVI组为（45．8±16．1）min,两组比较差异有统计学意义（P=0．019）。所有病例平均随访（17．1±7．8）个月,CPVA组复发率为5．3％,SPVI组为233％,两组比较差异有统计学意义（P=0．029）。两组均未发生严重并发症。结论导管射频消融治疗阵发性心房颤动,CPVA比SPVI具有更少的X线暴露时间和更低的复发率,且不增加手术时间和手术风险。     

Surgery for atrial fibrillation using radiofrequency catheter ablation: assessment of results at one year

Objective: The results obtained in 43 patients using direct intraoperative radiofrequency catheter ablation, as an alternative to surgical incisions, to perform atrial fibrillation surgery, are presented. Methods: Forty-three patients with ages ranging from 43 to 74 years ( ), with chronic atrial fibrillation with an average duration 6±5 years were operated. Eleven patients suffered from clinically relevant tachyarrythmia and eight had previous thromboembolic events. All but one patient had concomitant mitral valve surgery. Direct intraoperative radiofrequency catheter ablation was used to perform endocardial bilateral isolation of the pulmonary veins from the left atrium. Results: There were no local or general complications, namely bleeding or thromboembolic events. Of the 33 patients with more than 3 months of follow-up, 36% remained in atrial fibrillation (Santa Cruz score 0); 30% had Score 4; 18% had Score 3; 6% had Score 2; 9% had Score 1. Conclusions: We conclude that the use of intraoperative radiofrequency catheter ablation is fast and safe. Presently, this is our method of choice for surgical treatment of atrial fibrillation in mitral patients.     

Experience with unipolar radiofrequency ablation for atrial fibrillation

BACKGROUND: The cut and sew Cox maze procedure for atrial fibrillation (AF), although effective, is not widely used because of technical complexity, prolonged duration and significant risk of postoperative bleeding. This study reviews our experience with the unipolar radiofrequency ablation (RFA) procedure, which was used to create a modified maze to treat AF. METHODS: A retrospective review of 31 patients undergoing consecutive cardiac surgery who had concomitant RFA for AF over a 16-month period was carried out. A Cobra unipolar RFA probe (EPT; Boston Scientific, San Jose, CA, USA) was used to create a standard set of lesions. RESULTS: There were 20 men and 11 women (mean age, 66 +/- 9 years; range, 48-87 years). AF was continuous in 21 patients and intermittent in 10. The median duration of AF leading up to surgery was 48 months (range, 6 months-20 years). Left atrium was enlarged in 81% of the patients. Operations included mitral valve repair (7 patients), replacement (5), coronary artery bypass (10), aortic valve replacement (1) and combined procedures (8). There were no complications directly attributable to RFA. There were three early deaths. One patient required a permanent pacemaker. Median follow up was 22 months (range, 12-30 months). One patient died 2 years after the operation from a stroke. Cardioversion was attempted in five patients within 3 months of operation and was successful in four. At 2 years following the procedure, the probability of the patient remaining in sinus rhythm was 0.71 +/- 0.15. CONCLUSION: Surgical RFA can be carried out as a useful adjunct to conventional cardiac surgery. Although the results were satisfactory in this series, further studies are needed to refine the indication of the procedure and to assess its longer-term efficacy.     

心房颤动患者导管消融术后肢体制动与卧床时间研究

目的探讨心房颤动导管消融术后肢体制动与卧床时间对并发症、舒适程度的影响。方法将160例经房间隔穿刺行房颤消融术的患者按照时间顺序分为对照组(42例)、观察1组(60例)、观察2组(58例)。对照组采用沙袋压迫穿刺部位6h,8h后可床旁活动;观察1组术后沙袋压迫穿刺部位2h,4h后床旁活动;观察2组术后沙袋压迫穿刺部位2h,6h后床旁活动。结果三组出血、血肿发生率差异有统计学意义(P0.05),其中观察1组出血、血肿发生率高于对照组和观察2组;回室后4h、6h、8h三组疼痛评分比较,差异有统计学意义(均P0.01),其中对照组疼痛分值最高,其次是观察2组,观察1组最低;三组尿潴留发生率比较,差异有统计学意义(P0.05)。结论沙袋压迫2h,6h后下床活动没有增加房颤消融术患者出血、血肿、假性动脉瘤,动静脉瘘等并发症发生率,患者腰背部疼痛相对较轻。     

心房颤动患者射频消融术后运动恐惧的潜在剖面分析

目的 探究心房颤动（房颤）患者射频消融术后运动恐惧的特征差异,以期为临床开展精准干预提供参考。方法 选取上海市4所三级医院心内科门诊随访的475例房颤术后患者作为研究对象,采用一般资料调查表、心脏病患者运动恐惧量表、领悟社会支持量表进行调查。采用潜在剖面分析识别房颤患者射频消融术后运动恐惧特征的类别,采用有序多分类logistic回归进一步分析影响因素。结果 潜在剖面分析研究结果显示,房颤患者射频消融术后运动恐惧可分为低水平运动恐惧组（29.05%）、中等水平运动恐惧组（48.21%）和高水平运动恐惧组（22.74%）。三组年龄、文化程度、职业状态、居住方式、房颤病程、症状分级、领悟社会支持得分比较,差异有统计学意义（均P<0.05）。有序多分类logistic回归分析结果显示,文化程度为小学及以下和房颤症状分级是患者运动恐惧的危险性因素;房颤病程＜3年和领悟社会支持是患者运动恐惧的保护性因素（均P<0.05）。结论 房颤患者射频消融术后运动恐惧水平存在显著异质性,医护人员可依据不同人群特征给予针对性干预策略,以降低其术后运动恐惧水平。     

A modified surgical ablation line for atrial fibrillation. The Bachmann line

Surgical treatment of atrial fibrillation generally consists in the isolation of the pulmonary veins (“box-lesion”). Bachmann's bundle is a cardiac structure that may play an important role in the genesis of the atrial fibrillation. Surgical isolation of such bundle has not been reported before. We aim to describe how to perform minimally invasive epicardial pulmonary vein isolation along with the isolation of the Bachmann's bundle. Adding the surgical ablation line of Bachmann's bundle is a feasible, fast, and easy procedure that may be contribute to the reduction of atrial fibrillation relapses.     

射频消融迷宫术治疗心房纤颤

作者采用射频消融迷宫术治疗心房纤颤２０例，其中１９例合并风湿性二尖瓣病的患者，同时行瓣膜替换术，１例合并房间隔缺损患者进行修复。射频消融的路线采用小板井嘉夫的手术径路。术后１６例恢复窦性心律，占８０％，未恢复窦性心律的４例，２例为房颤，１例为房扑，另１例为结性心律。射频消融迷宫术耗时短，仅增加钳闭主动脉时间平均２０．５分钟，无术后出血的潜在危险。但术后７～１０天之内，有１８例出现过房颤、房扑、房速等室上性心律失常，可能由于射频消融不均匀，干扰心房的心电活动所致。     

左心房应变联合心电P波参数预测肺静脉隔离后阵发性心房颤动复发

目的 观察左心房应变联合心电P波参数预测以射频导管行肺静脉隔离（PVI）治疗阵发性心房颤动（PAF）后病变复发的价值。方法 前瞻性纳入首次接受PVI的88例PAF患者,根据治疗后6个月内心电图（ECG）结果将其分为复发组（n=30）及未复发组（n=58）。比较2组患者基本资料,左心房储备期应变（LASr）、左心房管道期应变（LAScd）、左心房收缩期应变（LASct）等经胸超声心动图（TTE）参数,以及P波时限、PR间期、P/PR（P波时限与PR间期比值）等ECG参数;对差异有统计学意义的参数行多因素logistic回归分析,筛选PAF经PVI后复发的独立预测因素,以受试者工作特征曲线及曲线下面积（AUC）评价各因素单独及联合预测效能,并以DeLong检验进行比较。结果 组间患者基本资料差异均无统计学意义（P均＞0.05）。相比未复发组,复发组LASr、LAScd程度减低而P/PR增大（P均＜0.05）。LASr（OR=0.805）、LAScd（OR=0.850）及P/PR（OR=1.119）均为PVI后PAF复发的独立预测因素（P均＜0.05）,其单独预测PVI后PAF复发的AUC分别为0.755、0.643及0.771,均低于三者联合（AUC为0.869）（P均＜0.05）。结论 TTE与ECG参数可用于预测PVI后PAF复发;LASr、LAScd及P/PR联合的预测效能优于各单一参数。     

分站式杂交消融术与微创迷宫消融术治疗长程持续性心房颤动随机对照研究的中长期随访结果

目的 评价并比较长程持续性心房颤动(房颤)患者接受分站式杂交消融术治疗的有效性是否优于单纯微创迷宫消融术.方法 纳入广东省人民医院南海医院2017～ 2018年行微创迷宫消融术术后3个月维持窦性心律患者108例,其中男82例、女26例,年龄(56.5±9.4)岁.其中50例为杂交手术(HA)组,补充行导管射频消融术;另...     

Noninvasive mapping before surgical ablation for persistent,long-standing atrial fibrillation

Objective

The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation.

微波消融治疗心房颤动在瓣膜手术中的应用

目的探索瓣膜手术同期微波消融治疗心房颤动的初步经验。方法对90例心脏瓣膜病合并持续性心房颤动患者,在瓣膜手术同期行心内膜微波消融。结果全组平均微波消融时间为(14.3±2.9)min。术后随访1~24个月,复发14例,治愈率84.4%,无消融相关并发症。结论瓣膜手术同期微波消融治疗心房颤动安全、有效。     

Incidence and clinical predictors of subsequent atrial fibrillation requiring additional ablation after cavotricuspid isthmus ablation for typical atrial flutter

Objectives: We sought to investigate the incidence of atrial fibrillation after catheter ablation for typical atrial flutter and to determine the predictors for symptomatic atrial fibrillation that required a further additional dedicated ablation procedure.

Design: 127 patients underwent elective cavotricuspid isthmus ablation with the indication of symptomatic, typical atrial flutter. The occurrence of atrial flutter, atrial fibrillation, cerebrovascular events and the need for additional ablation procedures for symptomatic atrial fibrillation was assessed during long-term follow-up.

Results: The majority of patients (70%) manifested atrial fibrillation during a follow-up period of 68?±?24 months, and a significant proportion (42%) underwent one or multiple atrial fibrillation ablation procedures after an average of 26 months from the index procedure. Recurrence of typical atrial flutter was rare. Ten patients (8%) suffered cerebrovascular events. Earlier documentation of atrial fibrillation (OR 3.53), previous use of flecainide (OR 3.33) and left atrial diameter (OR 2.96) independently predicted occurrence of atrial fibrillation during the follow-up. A combination of pre- and intra-procedural documentation of atrial fibrillation (OR 3.81) and previous use of flecainide (OR 2.43) independently predicted additional atrial fibrillation ablation.

Discussion: Atrial fibrillation occurred in the majority of patients after ablation for typical atrial flutter and 42% of them required an additional dedicated ablation procedure. Pre- and intraprocedural documentation of atrial fibrillation together with previous use of flecainide independently predicted atrial fibrillation occurrence and a need for additional ablation. Anticoagulation treatment should be continued in high-risk patients in spite of clinical disappearance of atrial flutter.     

Concomitant aortic valve-sparing operation and closed biatrial radiofrequency ablation for annuloaortic ectasia and paroxysmal atrial fibrillation

A 53-year-old woman was admitted for annuloaortic ectasia with moderate aortic valve insufficiency (AI) and paroxysmal atrial fibrillation. Concomitant aortic root replacement with a valve-sparing technique and closed biatrial procedure using bipolar radiofrequency ablation was performed successfully. Postoperative echocardiography showed trivial AI with regular sinus rhythm, which meant she could avoid anticoagulation therapy.     

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.