心脏瓣膜置换术同期直视下射频消融治疗风湿性瓣膜病合并慢性房颤效果观察

目的观察心脏瓣膜置换术同期直视下射频消融治疗对慢性风湿性瓣膜病合并心房纤颤的疗效。方法选择80例有瓣膜置换手术指征并伴有慢性心房纤颤的患者,随机分成治疗组和对照组各40例。治疗组在心脏瓣膜置换同期行冲洗式射频消融,对照组则未给予射频消融治疗。结果随访（8.6±3.1）个月,治疗组中34例术后恢复窦性心律,转复率为85%;对照组术后11例恢复了窦性心律,转复率为27.5%;两组房颤转复率相比,P〈0.05。两组均无明显并发症出现。结论心脏瓣膜置换术同期直视下射频消融治疗能安全有效地治疗风湿性瓣膜性心脏病伴慢性房颤。     

心内直视下同期改良冲洗式双极射频消融术治疗心脏瓣膜病并持续性心房颤动的有效性及安全性评价

目的评价心内直视下同期改良冲洗式双极射频消融术治疗心脏瓣膜病并心房颤动(AF)的有效性及安全性。方法选取2013年10月—2015年4月南京医科大学附属淮安第一医院收治的心脏瓣膜病并AF患者64例,采用随机数字表法分为对照组和观察组,每组32例。对照组患者行单极射频消融术,观察组患者行心内直视下同期改良冲洗式双极射频消融术;术后随访3~12个月。比较两组患者手术情况,术后1 d、3个月、6个月、12个月窦性心律维持情况,手术前后左心室射血分数(LVEF)及左心房前后径,并发症发生情况。结果两组患者消融时间、体外循环时间、主动脉阻断时间、住院时间比较,差异无统计学意义(P0.05)。两组患者术后1 d、3个月窦性心律维持率比较,差异无统计学意义(P0.05);观察组患者术后6、12个月窦性心律维持率高于对照组(P0.05)。两组患者手术前后LVEF、左心房前后径比较,差异无统计学意义(P0.05);两组患者术后LVEF与术前比较,差异均无统计学意义(P0.05),而两组患者术后左心房前后径均短于术前(P0.05)。两组患者并发症发生率比较,差异无统计学意义(P0.05)。结论心内直视下同期改良冲洗式双极射频消融治疗心脏瓣膜病并持续性AF安全有效,可有效缩短左心房前后径,维持术后窦性心律。     

外科射频消融改良迷宫术治疗大左心房心脏瓣膜病并发心房颤动的临床疗效

目的:探讨外科射频消融改良迷宫术治疗大左心房(左心房前后径≥60 mm)心脏瓣膜病并发心房颤动的临床疗效。方法:回顾性分析2014-01至2015-12在我院行心脏瓣膜置换术并同期采用Medtronic双极消融系统按改良迷宫Ⅲ手术路线射频消融(射频消融改良迷宫术)治疗心房颤动的风湿性心脏病患者267例。根据左心房大小将患者分为左心房前后径60 mm组(n=182)和左心房前后径≥60 mm组(n=85)。术后进行系统随访至少6个月,对比两组患者外科射频消融改良迷宫术治疗心房颤动的疗效。结果:(1)所有患者手术均顺利完成,射频消融时间左心房前后径60 mm组18~32(24±4)min,左心房前后径≥60 mm组22~38(25±6)min,差异无统计学意义(P0.05)。(2)恢复窦性心率患者的构成比:手术结束及出院时左心房前后径60 mm组分别为156例(86%)、152例(84%),左心房前后径≥60 mm组分别为56例(66%)、54例(64%);术后3个月、6个月,左心房前后径60 mm组分别为149例(81.6%)和146例(80.2%),左心房前后径≥60 mm组为48例(56.4%)和46例(54.1%),差异均有统计学意义(P均0.05)。(3)267例患者,均无需安装永久起搏器,无手术死亡和射频相关并发症。结论:射频消融改良迷宫术治疗心脏瓣膜病合并心房颤动,左心房前后径≥60 mm组的疗效逊于左心房前后径60 mm组,但总体疗效仍是安全、简便,有一定的疗效。大左心房的心脏瓣膜病患者心房颤动射频消融改良迷宫术仍值得在临床推广应用。     

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.     

同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术的临床疗效

目的 总结同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术治疗心脏瓣膜病、冠心病及房颤患者的临床疗效。 方法 选取手术治疗的心脏瓣膜病、冠心病并发房颤患者188例的临床资料，由患者及其家属自愿选择是否同期实施房颤射频消融术。分为同期消融组（n=96）和非消融组（n=92）。同期消融组患者行同期心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术，非消融组患者仅进行心脏瓣膜手术和冠脉搭桥术。通过对比两组患者体外循环转机时间、主动脉阻断时间、呼吸机插管时间、心外科ICU监护时间和术后普通病房住院时间，出院后随访12个月，根据随访结果，记录术后6个月、12个月窦性心律转复率、心功能指标；12个月内主要心血管不良事件（MACCE，包括恶性心律失常、充血性心力衰竭、脑血管栓塞）发生率，评价其临床疗效。 结果 体外循环转机时间，主动脉阻断时间，差异有统计学意义（P<0.05）；两组呼吸机插管时间，心外科ICU监护时间和术后普通病房住院时间，差异无统计学意义；术后6个月、12个月窦性心律转复率，同期消融组优于非消融组（P<0.05），患者术后6个月、12个月心功能指标(左心房内径、NT-proBNP、左室射血分数)，同期消融组优于非消融组（P<0.05）；同期消融组12个月内MACCE发生率显著低于非消融组（P<0.05）。 结论 对同时患心脏瓣膜病、冠心病及房颤患者，同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术，窦性心律转复率更高，临床疗效更好。     

双极射频消融及迷宫术治疗风湿性心脏病合并长期持续性心房颤动

目的评价应用双极射频消融系统同时行迷宫术（MazeⅢ）治疗风湿性心脏瓣膜病合并长期持续性心房颤动（房颤）的近期疗效。方法2007年5月至2008年5月,13例风湿性心脏瓣膜病合并长期持续性房颤患者在瓣膜置换术同时行双极射频消融Mazem术。患者年龄56．5（44—65）岁,房颤持续时间5（2—11）年,左心房内径（55．1±5．9）mm。随访并评价手术疗效。结果本组无死亡等严重并发症,平均主动脉阻断时间10min,术后即刻、出院时及平均随访（9．2±3．2）个月时房颤消融成功率分别为100％、84．6％及92．3％。结论瓣膜置换术同时行双极射频消融MazeⅢ术治疗风湿性心脏瓣膜病合并长期持续性房颤安全可行,近期疗效好。     

外科射频消融改良迷宫对大左心室心脏瓣膜病合并心房颤动的效果评价及预后

目的探讨外科射频消融改良迷宫对大左心室心脏瓣膜病合并心房颤动的效果评价及预后。方法选择2016年1月至2018年2月于北京安贞医院心外科接受治疗的大左心室心脏瓣膜病合并心房颤动患者134例,随机分成对照组和研究组。对照组采取心脏瓣膜置换术治疗,研究组采取外科射频消融改良迷宫法治疗。比较两组患者的临床资料,手术射频消融时间和手术后恢复窦性心律的状况,患者在手术后半年内房颤持续时间的比较及术后的效果评价。结果治疗后,研究组的手术射频消融时间以及手术后恢复窦性心律的状况均明显优于对照组(P0.05);治疗后,研究组患者在手术后半年内房颤持续的时间明显短于对照组(P0.05);研究组满意率为83.5%,对照组为44.7%,研究组患者的疗效满意率明显优于对照组(P0.05)。结论在治疗大左心室心脏瓣膜病合并心房颤动中,运用外科射频消融改良迷宫的方法效果理想,可在临床推广使用。     

直视下左心房后壁射频消融微创迷宫术治疗风湿性心脏病心房颤动的临床对照研究

目的 通过对照观察探讨心脏瓣膜置换手术(换瓣术)过程中直视下微创迷宫术法射频消融左心房后壁治疗风湿性心脏病(风心病)慢性心房颤动(房颤)的可行性及疗效.方法 128例行心脏瓣膜置换术的风心病伴慢性房颤患者中,76例在换瓣术中直视下以微创迷宫术法射频消融左心房后壁,设计两条迷宫线路:一条为围绕4个肺静脉口外侧的环形线,另一条为连接左下肺静脉口下缘与二尖瓣后叶根部的最短直线.术中分次节段性消融,输出功率30～40W,放电时间45～60 S;术前3 d静脉应用胺碘酮,术后口服3个月停药;随访24个月.其余52例拒绝行射频消融微创迷宫术的风心病患者设为对照组,其换瓣术、胺碘酮应用及术后随访同射频消融微创迷宫术组(消融组).结果 随访24个月,消融组成功率81.58%(62/76),对照组成功率44.23%(23/52),P＜0.001,差异有统计学意义.结论 换瓣术中采用直视下在左心房后壁行射频消融微创迷宫术法能显著提高术后维持窦性心律的成功率,比传统的药物治疗疗效好,且方法简单,并发症少.胺碘酮有助于逆转心房电重构,减少房颤复发.     

探讨外科射频消融改良迷宫术治疗大左心房心脏瓣膜病并发心房颤动的临床效果

目的 研究外科射频消融改良迷宫术治疗大左心房心脏瓣膜病并发心房颤动的效果。方法 对2020年1月到2020年5月我院收治的133例大左心房心脏瓣膜病并发心房颤动患者,以左心房前后径60mm作为界限将其分为两组,大于60mm的为对照组,小于60mm的为观察组,观察组和对照组数量分别为64例和69例,对两组临床各项指标和数据进行分析和对比。结果 观察组与对照组射频消融时间基本保持一致,差异无统计学意义（P> 0.05）;观察组术后不同时间点恢复窦性心律的患者数量明显多于对照组,P <0.05;对手术开展之前与术后1周两组患者心电图指标恢复情况做出分析和对比,观察组左房内径与左室舒张末径两项临床指标明显更接近临床目标值,P <0.05;对两组患者术后半年心功能等级情况进行统计和分析,观察组Ⅰ级、Ⅱ级数量明显多于对照组,P <0.05。结论 对于大左心房心脏瓣膜病并发心房颤动患者来说,左心房前后径<60mm的更适合应用外科射频消融改良迷宫术治疗,临床治疗效果明显更符合预期,术后心功能情况明显得到好转,手术后患者的生活质量也得到明显提升,对于临床治疗效果更为满意。     

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。     

改良左房折叠术在风湿性心脏病并发心房纤颤的临床应用

目的探讨改良左房折叠术治疗心房纤颤（房颤）的有效性。方法：210例风湿性心脏病并发房颤的患者[所有患者均因个人原因未选择瓣膜置换术中行射频消融术,各组患者术前年龄、左房内径（LAD）差异无统计学意义],在行瓣膜置换（单瓣115例,双瓣95例）的同时随机分为3组：改良组（71例,即瓣膜置换的同时行改良左房折叠术）、常规A组（对照组1,68例）和常规B组（对照组2,71例）行常规左房折叠术,术后测量患者LAD、左室射血分数（LVEF）值,观察改良左房折叠术治疗房颤的有效性。结果：术前、术后相同心脏超声平面显示改良组术后LAD显著减小,且改良组房颤转复率1月高达31％,明显高于常规A组（12％）和B组（7％）。术后12个月随访发现,改良组房颤转复率为18％,与常规A组（6％）和常规B组（4％）相比有统计学意义（P〈0．05）。结论：在行瓣膜置换术的同时,改良左房折叠术作为附加术式在一定程度上可有助于转复患者房颤心律为窦性心律。     

瓣膜置换同时射频消融隔离肺静脉治疗风湿性瓣膜性心脏病永久性房颤

目的观察瓣膜置换同时肺静脉隔离治疗风湿性瓣膜性心脏病永久性房颤的疗效。方法风湿性瓣膜性心脏病瓣膜置换手术中合并房颤患者34例,17例消融组,17例对照组,消融组运用自制射频消融圈分别对4个肺静脉进行射频消融,术后随访,了解手术疗效。结果两组临床基线一致,平均随访（9．9±2．2）个月,消融组房颤转复率52．9％,对照组房颤转复率17．6％,两组差异有统计学显著意义（P〈0．05）。结论心内膜射频消融隔离肺静脉能安全、较有效地治疗风湿性瓣膜性心脏病永久性房颤。     

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。     

Efficiency of radiofrequency ablation for surgical treatment of chronic atrial fibrillation in rheumatic valvular disease

Background

It remains unclear whether concomitant radiofrequency ablation procedure in valvular surgery could offer additional benefits to patients with rheumatic valvular disease. We designed a prospective and randomized control study to evaluate the efficacy of surgical radiofrequency ablation in patients with rheumatic heart disease.

Methods

From June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic heart disease were randomized: (1) control group, patients underwent only valve replacement followed by amiodarone for rhythm control, (2) left atrial group (LA group), patients underwent valve replacement and left atrial mono-polar radiofrequency ablation, (3) bi-atrial group (BA group), patients underwent valve replacement and bi-atrial mono-polar radiofrequency ablation. The primary endpoints included: cardiac death, stroke, and recurrent AF after discharge.

Results

There was no perioperative death. One patient died 4 months after MVR in BA group. In univariate Cox analysis, the two ablation groups were associated with less AF (BA group vs control group: P < 0.001; LA group vs control group: P < 0.001) as well as atrial tachycardia arrhythmia (AF/AT/AFL) recurrent (BA group vs control group: P < 0.001; LA group vs control group: P = 0.02). The comparison between BA and LA groups revealed no differences in terms of AF (P = 0.06) or AF/AT/AFL (P = 0.09). Atrial transport function restoration rate 12 months after operation was 31.4% in LA group, 32.9% in BA group, and 8.6% in control group respectively (P < 0.01).

Conclusions

Radiofrequency ablation concurring with valvular surgery can bring a higher sinus rhythm restoration rate when compared with medical anti-arrhythmic drug therapy in low-medium risk rheumatic heart disease.The trial was registered on Clinicaltrials.gov (registry number NCT01013688).     

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.     

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.     

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。     

瓣膜置换、房颤射频消融术治疗房颤的临床护理研究

目的：分析探讨瓣膜置换 房颤射频消融术治疗房颤患者的临床护理方法与效果。方法：选择我院2014年1月-2014年12月之间收治的行瓣膜置换 房颤射频消融术治疗的36例患者作为观察对象,采用随机的方式将其分为观察组和对照组各18例。对照组患者采取常规的护理干预;观察组患者应用系统护理方法。分析对比两组患者的临床治疗效果及患者满意度。结果：观察组患者术后出现并发症的比例小于对照组,差异具有统计学意义(P＜0.05);同时观察组患者对护理服务的满意度显著高于对照组,差异同样具有统计学意义(P＜0.05)。结论：对瓣膜置换 房颤射频消融术治疗房颤患者应用系统的护理干预具有很好的改善效果,构建和谐的护患关系,值得在临床中推广。