微波消融治疗心房颤动在风湿性心脏病二尖瓣置换术中的应用

目的研究风湿性心脏病二尖瓣手术同期行心内膜微波消融术治疗持续性心房颤动(简称房颤)的效果。方法66例患者随机分为两组,33例在二尖瓣手术中行心内膜微波消融治疗,另外33例设为对照组,单独行瓣膜手术。结果微波组主动脉阻断时间、体外循环时间长于对照组(63.818±17.738 min vs 47.545±18.018 min;108.879±32.191 min vs 85.333±22.885 min。P均<0.05)。术后两组均未出现严重并发症。随访2.3±1.4年,微波组中24例(72.7%)维持窦性心律,对照组中5例(15.2%)为窦性心律,两组比较,P<0.05。术后6个月、2年,微波组左房内径明显小于对照组(P<0.05);术后2年,微波组三尖瓣返流量明显低于对照组(P<0.05)。结论微波消融治疗房颤安全、效果确切,可延缓术后左房内径变大及三尖瓣返流的进展。     

心内直视术中射频消融治疗风湿性心脏瓣膜病合并心房颤动

目的研究心内直视术中射频消融风湿性心脏病合并心房颤动的疗效。方法瓣膜手术同期行射频消融术病例15例,年龄32～58(44±8)岁,临床确诊风湿性瓣膜病合并心房颤动,心房颤动史1～7年。其中阵发心房颤动1例,持续性心房颤动14例,二尖瓣病变11例,双瓣病变4例,合并中度三尖瓣关闭不全7例。射频消融时间20～35(25.0±2.2)min。术后随访3～12月。结果15例病人升主动脉开放后复搏心律均为非心房颤动。2例术后住院期间出现快速型房性心律,经抗心律失常药处理转为窦性;1例出院时为结性心律;术后3个月呈窦性心律12例,6个月呈窦性心律11例。术后无死亡病例,心功能均恢复为1～2级,未见出血及栓塞。结论术中射频消融治疗风湿性心脏病合并心房颤动安全有效、操作简单、容易掌握,值得临床推广。     

心内直视术中射频消融治疗风湿性心脏瓣膜病合并心房颤动

目的 研究心内直视术中射频消融风湿性心脏病合并心房颤动的疗效.方法 瓣膜手术同期行射频消融术病例15例,年龄32～58(44±8)岁,临床确诊风湿性瓣膜病合并心房颤动,心房颤动史1～7年.其中阵发心房颤动1例,持续性心房颤动14例,二尖瓣病变11例,双瓣病变4例,合并中度三尖瓣关闭不全7例.射频消融时间20～35(25.0±2.2)min.术后随访3～12月.结果 15例病人升主动脉开放后复搏心律均为非心房颤动.2例术后住院期间出现快速型房性心律,经抗心律失常药处理转为窦性;1例出院时为结性心律;术后3个月呈窦性心律12例,6个月呈窦性心律11例.术后无死亡病例,心功能均恢复为1～2级,未见出血及栓塞.结论 术中射频消融治疗风湿性心脏病合并心房颤动安全有效、操作简单、容易掌握,值得临床推广.     

射频消融迷宫术治疗心房颤动疗效观察

目的 :探讨直视下射频消融迷宫术治疗心房颤动 (房颤 )的效果。方法 :选取 136例风湿性心脏病并发房颤患者 ,在体外循环心内直视下行射频消融迷宫术 ,同时行瓣膜替换术 ;另选取 18例患者 (包括风湿性心脏病并发房颤 13例 ,先天性心脏病并发房颤 5例 )在体外循环心内直视下行单纯右心房射频消融术 ,同时行瓣膜替换及其他心内畸形矫治。结果 :无手术死亡。射频消融迷宫术组有 112例恢复了窦性心律 ,占 82 .4 %;单纯右心房射频消融术组 11例恢复了窦性心律 ,占 6 1.1%。结论 :射频消融迷宫术治疗房颤成功率高 ,方法简单 ,效果满意 ,危险性小。     

非体外循环下心外膜微波消融治疗心房颤动的临床效果

目的探索非体外循环下心外膜微波消融术治疗心房颤动(房颤)的临床应用效果。方法从2003年4月至2005年4月对46例持续性房颤患者进行了非体外循环下心外膜消融术,其中二尖瓣病变28例、二尖瓣合并主动脉病变5例,冠心病8例、孤立性房颤5例。将FLEX10微波探头完整包绕4个肺静脉入口及下腔静脉开口至三尖瓣环,微波能量65W、90s进行连续性心外膜消融,然后在体外循环下行瓣膜置换术或不停跳冠状动脉旁路术。术前平均左房直径(52.5±15.3)mm,左室射血分数42%~70%。所有病例均于出院时和术后3、6、12个月行标准12导联心电图、24hHolter、超声心动图及临床检查进行随访。结果本组病例均成功进行了心外膜微波消融术并于术中消除房颤,无手术死亡及手术相关的并发症。微波消融时间平均(37.7±7.8)min,成功率为63.0%;随访窦性心律维持率:出院时为63.0%,3个月为66.7%,6个月为72.7%,12个月为80.6%,且左房内径<50mm。结论非体外循环下心外膜微波消融术可以达到肺静脉电学隔离治疗房颤的目的,在合并或不合并心脏器质性病变的持续性房颤外科治疗中有较低的风险和良好效果。     

冲洗射频改良迷宫Ⅲ手术治疗心房颤动的临床效果观察

目的:对合并心房颤动(房颤)的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,评价冲洗射频改良迷宫Ⅲ手术在心内直视手术中治疗房颤的临床效果。方法:从2004-05开始,采用Medtronic公司的射频消融系统对115例合并房颤的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,其中包括双瓣置换术48例、二尖瓣置换术49例、主动脉瓣置换术2例、冠状动脉搭桥术同时行瓣膜置换术11例、冠状动脉搭桥术1例、三尖瓣置换术1例、其他手术3例。术后应用胺碘酮6个月。结果:115例患者手术当日109例房颤消除,其中95例为窦性心律,14例为结性心律;6例仍为房颤心律,房颤消除率为94.8%。术后随访3个月,82例维持窦性心律,10例为房性心律,房颤消除率为80%;14例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;9例仍为房颤心律。随访12～24个月,全组115例患者中80例维持窦性心律,11例为房性心律,房颤消除率为79.1%;9例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;15例为房颤。结论:冲洗射频消融改良迷宫手术在治疗合并有房颤的心脏疾病的心内直视手术中安全、简便、易于操作...     

体外循环下心脏瓣膜置换术同期双极射频消融治疗心房颤动

目的:评估体外循环下心脏瓣膜置换术同期行双极射频消融治疗心房颤动(房颤)。方法:纳入2015年1月至2019年10月丹阳市人民医院及镇江市第一人民医院连续58例瓣膜置换同期行双极射频消融术的房颤患者,其中非风湿性瓣膜病16例,风湿性心脏瓣膜病42例。术中房颤消融路线均一致,常规结扎切除左心耳。同期行体外循环下二尖瓣置换56例,行主动脉瓣置换25例,行三尖瓣成形38例,行血栓清除术10例。术后常规口服胺碘酮3~6个月,所有患者均随访12个月,记录患者术后房颤转复情况。结果:术后恢复为窦性心律44例(75.8%),发生心房扑动8例(10.3%),消融后仍为房颤9例(15.5%),出院前恢复为窦性心律47例(81.0%)。结论:在体外循环下心脏瓣膜置换术同期行双极射频消融治疗房颤的临床效果满意,并具有安全性高、容易操作的特点。     

冷冻联合射频消融治疗二尖瓣病变合并房颤的疗效分析

目的 评价冷冻联合射频消融治疗二尖瓣病变合并房颤的疗效。方法 回顾性分析上海交通大学医学院附属新华医院2019年06月至2021年06月完成的75例接受同期二尖瓣手术和冷冻联合射频消融治疗房颤患者的临床资料。其中男34例,女41例,年龄39～77岁。术前二尖瓣病变情况：二尖瓣狭窄11例,二尖瓣关闭不全37例,二尖瓣狭窄合并关闭不全27例。房颤中位病程3(0.75,5)年,其中持续性房颤26例,长程持续性房颤49例。左心房内径（52.29±6.97）mm;左心室射血分数（59.19±9.17）%。全身麻醉、体外循环下施行手术,先行冷冻联合射频房颤消融术,再行二尖瓣手术。结果 所有患者均顺利完成心脏瓣膜手术及冷冻联合射频房颤消融术。围术期死亡1例,为二、三尖瓣修复及房颤消融患者,因肺部感染于术后59 d死于呼吸衰竭。出院时,70例（94.6%）维持窦性心律。术后随访12～36(23.0±6.7)个月,失访1例;随访期间发生1例患者死亡,术后1年死于心力衰竭。2例患者置入心脏永久起搏器（1例窦房结功能障碍,1例房室传导阻滞）。Kaplan-Meier生存曲线表明,术后第1年累计窦性心律维持率...     

风湿性心脏病合并心房颤动术中射频消融治疗的临床研究

目的:评价心内直视下射频消融(RFA)治疗风湿性心脏病合并心房颤动(AF)的手术疗效。方法:2003年8月至2004年4月,60例风湿性心脏病合并AF患者,其中男性25例(41.7%),女性35例(58.3%),年龄25～72岁,平均(50.77±1.43)岁,AF病史为1～240个月,平均(47.18±1.43)个月。心功能(NYHA)分级Ⅱ级16例,Ⅲ级39例,Ⅳ级5例,手术方式为二尖瓣或和主动脉瓣膜手术,同期三尖瓣成形22例、冠状动脉旁路移植术5例、左心房血栓清除12例,术中对AF进行RFA手术。结果:全组体外循环时间(112.58±28.31)min、平均心肌阻断时间(71.18±22.22)min,RFA手术时间平均(17.88±0.59)min。术后当日心律:窦性心律46例76.7%(4660),AF心律4例6.7%(460),结性和起搏心律患者AF转为窦性,为结性心律10例15.6%(1060);术后随访率83.3%(5060),平均随访(12.58±0.32)个月,术后远期76%(3850)保持窦性心律。结论:术中RFA术对风湿性心脏病合并AF患者是简单、有效的治疗方法,无明显增加体外循环与阻断时间。     

心脏瓣膜手术同期行射频消融术后血栓和出血事件发生率的研究

目的:研究心脏瓣膜手术同期行射频消融术治疗永久性心房纤颤(房颤)术后脑血管事件的发生。方法:回顾2003年1月至2006年12月758例瓣膜病合并房颤病例,其中行瓣膜手术+房颤射频消融374例(射频消融组),仅行瓣膜手术384例(对照组)。术后随访6～54个月,平均(32±6.23)个月,对比分析2组病例术后脑血管事件随访数据。结果:术后随访证实消融组在术后脑血管事件发生率、生存率、窦性心律转复率等均优于对照组。结论:心脏瓣膜置换术同期行射频消融术治疗永久性房颤的远期疗效确切,可降低脑血管事件的发生,并提高远期生存率、窦性心律转复率。     

Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery

Late recovery of sinus rhythm is unusual in patients with permanent AF treated by (radiofrequency) RF maze procedure during mitral valve surgery. Identification of clinical and instrumental preoperative factors predictive of early success of RF ablation in patients with permanent AF undergoing mitral valve surgery may improve selection of subjects to obtain long-term results. Hundred and thirty consecutive patients with permanent AF and mitral valve disease underwent modified RF maze procedure during concomitant mitral valve surgery. Rheumatic valve disease (61 pts) and mitral valve prolapse (41 pts) were the more common aetiology of valve abnormalities. Mitral valve replacement was performed in 54 % of patients and mitral valve repair in the remaining 46 %. Four patients died after surgery. At discharge, 87 patients (69 %) were in sinus rhythm (group 1) and 43 patients in AF persisted (group 2). At an average 24-month follow-up, sinus rhythm was present in 67 % of patients, and 33 % were in atrial fibrillation. In this period, late recovery of sinus rhythm was observed only in five patients, while eight discharged in sinus rhythm developed again atrial fibrillation. Among preoperative parameters at univariate analysis female sex, atrial fibrillation >24 months, left atrial diameter >54 mm, left atrial area >24 cm², rheumatic valve disease and NYHA class were associated with persistence of AF. At Cox regression multivariate analysis, increased left atrial area (OR 1.07 per unit increase—95 % CI 1.01–1.131) and rheumatic aetiology of valve disease (OR 4.52, 95 % CI 1.65–12.4) were associated with persistence of AF at hospital discharge. Persistence of AF after RF ablation in patients undergoing mitral valve surgery is related to aetiology, e.g. rheumatic valve disease, and to increasing left atrial diameter. Due to low rate of late recovery of sinus rhythm, indication to RF ablation associated with MV surgery should be carefully considered in patients with large atria and rheumatic mitral valve disease.     

Ablation of atrial fibrillation using microwave energy--early experience

Between Dec 12, 2002 and Aug 22, 2004, 84 operative patients with chronic atrial fibrillation (AF) were subjected to AF ablation with microwave energy. Of these, 49 patients were female; their ages ranged between 20 and 72 years (mean, 43.1 years). Most patients suffered from mitral disease, accompanied in over one third of cases with tricuspid insufficiency. Thirteen patients had aortic valve disease, mostly with mitral involvement. Three patients had coronary artery disease, three had atrial septal defect and one had a left atrial (LA) myxoma. Seventy-two patients underwent endocardial ablation and 12 patients underwent epicardial ablation. Operative mortality was 4 (4.8%), and there were no major untoward postoperative events. Fifty seven patients (71.3%) had their AF converted to sinus rhythm immediately after surgery. Amiodarone or sotalol was used in all postoperative patients for 6 months, except in 8 who had bradycardia. Electrical defibrillation was utilized in cases of atrial flutter or persistent AF. Seventy patients were followed for at least 6 months. In total, 52 of them (74.3%) are still in sinus rhythm. We believe microwave ablation is a satisfactory and safe method of AF ablation, and because it is brief, it can be added to surgical procedures without undue risk to the patient.     

风湿性心脏病瓣膜置换术后心房颤动的导管消融病例总结

目的：评价风湿性心脏病瓣膜置换术后心房颤动（房颤）消融的效果和安全性。方法入选2008年至2013年在广东省人民医院心内科接受房颤导管消融治疗的风湿性心脏病瓣膜置换术患者,分析其临床特征、消融策略及消融成功率。结果共纳入23例患者,男8例,女15例,平均年龄（51.0＆#177;9.2）岁。单纯二尖瓣置换术患者13例（56.5%）,二尖瓣、主动脉瓣双瓣置换术10例（43.5%）,其中5例同时进行三尖瓣置换或整形术。外科术后阵发性房颤患者14例（60.9%）,非阵发性房颤9例（39.1%）;这些患者在外科术前心律情况为9例窦性心律,4例阵发性房颤,10例非阵发性房颤。导管消融距离外科手术时间为（6.9＆#177;5.8）年,外科术后发生房颤病程（3.1＆#177;3.2）年,左、右心房内径分别为（44.1＆#177;5.9）mm、（48.1＆#177;9.0）mm,左心室射血分数64.0%＆#177;8.3%。平均消融手术时间（156.8＆#177;46.6）min,X线曝光时间（27.3＆#177;11.2）min。随访（29.7＆#177;21.2）个月,其中4例（17.4%）患者接受再次消融术;14例（60.9%）维持窦性心律（6例服用胺碘酮）,1例死亡,2例失访,6例复发（包括2例持续性房颤,1例阵发性房颤,2例偶发性心房扑动,1例阵发性房性心动过速）。结论风湿性心脏病瓣膜置换术后房颤导管消融有效、安全,步进式导管消融策略可能较为合适。     

Hemodynamic effects and long-term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation

BACKGROUND: The presence of atrial fibrillation (AF) has been identified as a predictor of a suboptimal result in some patients undergoing percutaneous balloon valvuloplasty in the treatment of symptomatic rheumatic mitral stenosis. HYPOTHESIS: Atrial fibrillation adversely affects the short- and long-term outcome of patients with mitral stenosis undergoing percutaneous balloon valvuloplasty. METHODS: A retrospective chart review of 104 consecutive patients with rheumatic mitral stenosis undergoing percutaneous balloon valvuloplasty was performed. A successful procedure was defined as a final mitral valve area > or = 1.5 cm2 and the absence of a complication. Endpoints included freedom from mitral valve replacement, death, and repeat balloon valvuloplasty at 5 years. RESULTS: A successful procedure was obtained in 89% of patients with sinus rhythm and in 78% of patients with AF (p = NS). Patients in sinus rhythm had a greater cardiac output resulting in a larger final valve area than patients in AF (1.8 vs. 1.6 cm2, p < 0.05). Freedom from valve replacement, death, and repeat balloon valvuloplasty at 5 years was 75% for patients in AF and 76% for patients in sinus rhythm (p = NS). Lower postprocedure mitral regurgitation grade and absence of prior commissurotomy were the only independent predictors of event-free survival. CONCLUSIONS: Patients with mitral stenosis and AF have lower cardiac outputs and gradients than patients with sinus rhythm, despite similar valve areas. The long-term outcome of balloon valvuloplasty is independent of the initial cardiac rhythm.     

瓣膜置换术中双极射频消融治疗风湿性心脏病合并心房颤动

目的 探讨风湿性心脏瓣膜病合并心房颤动（AF）患者同期行瓣膜替换术及双极射频消融迷宫术的近期手术效果.方法 选取风湿性心脏瓣膜病合并心房颤动患者18例（消融组）,同期行瓣膜替换术及双极射频消融迷宫术治疗心房颤动.18例配对仅行心脏瓣膜替换术而未行双极射频消融迷宫术的患者作为对照组.患者年龄36～65岁,平均53.5岁,房颤持续时间1～10年,平均5年,左心房内径为44～67 mm.比较两组患者的手术治疗结果.结果 消融组18例患者术后窦性心律16例,房颤心律1例,结性心律1例;随访8个月,15例维持窦性心律,3例阵发性房颤心律.对照组13例术中心脏复跳后即为房颤心律,5例心脏复跳后为窦性心律,术后24 h内均转为房颤心律,应用胺碘酮不能持续恢复窦性心律.两组术后左房内径均较术前显著降低（P＜0.01）,消融组术后左房内径小于对照组[（33.06±2.88）mm比（36.16±2.43）mm,P＜0.05].结论 风湿性心脏瓣膜病合并慢性心房颤动患者在行瓣膜替换术的同时行附加的双极射频消融手术疗效良好,安全简便.     

Time to Cardioversion of Recurrent Atrial Arrhythmias After Catheter Ablation of Atrial Fibrillation and Long‐Term Clinical Outcome

Introduction: It is unclear whether early restoration of sinus rhythm in patients with persistent atrial arrhythmias after catheter ablation of atrial fibrillation (AF) facilitates reverse atrial remodeling and promotes long‐term maintenance of sinus rhythm. The purpose of this study was to determine the relationship between the time to restoration of sinus rhythm after a recurrence of an atrial arrhythmia and long‐term maintenance of sinus rhythm after radiofrequency catheter ablation of AF. Methods and Results: Radiofrequency catheter ablation was performed in 384 consecutive patients (age 60 ± 9 years) for paroxysmal (215 patients) or persistent AF (169 patients). Transthoracic cardioversion was performed in all 93 patients (24%) who presented with a persistent atrial arrhythmia: AF (n = 74) or atrial flutter (n = 19) at a mean of 51 ± 53 days from the recurrence of atrial arrhythmia and 88 ± 72 days from the ablation procedure. At a mean of 16 ± 10 months after the ablation procedure, 25 of 93 patients (27%) who underwent cardioversion were in sinus rhythm without antiarrhythmic therapy. Among the 46 patients who underwent cardioversion at ≤30 days after the recurrence, 23 (50%) were in sinus rhythm without antiarrhythmic therapy. On multivariate analysis of clinical variables, time to cardioversion within 30 days after the onset of atrial arrhythmia was the only independent predictor of maintenance of sinus rhythm in the absence of antiarrhythmic drug therapy after a single ablation procedure (OR 22.5; 95% CI 4.87–103.88, P < 0.001). Conclusion: Freedom from AF/flutter is achieved in approximately 50% of patients who undergo cardioversion within 30 days of a persistent atrial arrhythmia after catheter ablation of AF.     

Efficacy of intra-operative radiofrequency ablation in patients with permanent atrial fibrillation undergoing concomitant mitral valve replacement

BACKGROUND: Permanent atrial fibrillation (AF) is present before operation and persists after surgery in 30-40% of patients undergoing mitral valve surgery. Using the maze procedure, 75-82% of patients can be cured of AF, but the procedure is difficult and long lasting. Percutaneous radiofrequency (RF) ablation has emerged as an effective therapy for AF in recent years. AIM: To assess the efficacy of intra-operative RF ablation of AF in patients undergoing mitral valve surgery. METHODS: 100 adults with permanent AF underwent mitral valve replacement. Patients were divided into two groups: the RF group--50 patients qualified for mitral valve replacement and RF ablation; and the control group--50 patients selected for mitral valve replacement without ablation. Odds ratio and 95% confidence interval were examined to assess the influence of several factors on the outcome (free from AF during one-year follow-up based on symptoms and serial Holter ECG recordings). RESULTS: Baseline clinical, demographic and echocardiographic characteristics were similar in both groups. Electrical cardioversion following surgery was required in 76% of patients from the RF group compared with 94% from the control group (p<0.002). In those who underwent cardioversion, sinus rhythm was restored more frequently in RF than control patients (32 vs. 16%, p<0.002). Sinus rhythm at hospital discharge was present in 56% of RF patients compared with 22% of controls (p=0.0001), and after one-year follow-up in 54 vs. 16% (p<0.001), respectively. The use of amiodarone was significantly lower in RF patients compared with controls (32 vs. 70%, p<0.05). NYHA class III (OR 8.5, CI 1.0-394) or IV (OR 36, CI 1.2-1958) and left atrial diameter >6 cm (OR 9.3, CI 0.5-5230) were identified as predictors of AF. CONCLUSIONS: Intra-operative RF ablation performed in the left atrium in patients with chronic AF undergoing mitral valve replacement significantly improves sinus rhythm restoration rate. Advanced heart failure (NYHA class IV) and left atrial diameter >6 cm are negative prognostic factors for sinus rhythm maintenance.     

二尖瓣置换术后患者持续性心房颤动心率控制与节律控制的对比分析

目的 研究风湿性心脏病(风心病)二尖瓣置换术后心率控制与节律控制对患者远期预后的影响.方法 本试验采用回顾性分析.选择2006年在我院择期行二尖瓣置换术的患者197例,按术后心律情况分为窦性心律组(n=100)和心房颤动(房颤)组(n=97).收集患者基本资料,以患者手术结束为试验起始时间,随访术后发生脑卒中及心脏性死...