心脏直视手术同期双极射频消融迷宫术治疗心房颤动

目的:探讨心内直视下同期双极射频消融治疗器质性心脏病合并心房颤动的经验及疗效.方法:2008年12月至2010年2月间采用Cardioblate<,TM>冲洗式双极射频消融机为21例器质性心脏病(19例为风湿性瓣膜病、2例为先天性心脏病)合并心房颤动患者施行消融术,其中持续性/永久性房颤17例,阵发性房颤4例,消融经线...     

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.     

风心病瓣膜手术中射频改良迷宫术治疗心房颤动

心房颤动（简称房颤）是风湿性心脏瓣膜病患者常见的伴发病。2005年6月至2007年6月，我们为34例风湿性心脏病合并房颤患者行心脏瓣膜置换术，同时采用心内直视冲洗式射频消融改良迷宫术治疗房颤，取得了较好的效果，现报道如下。     

瓣膜手术同期行射频消融迷宫手术治疗心房颤动的疗效观察

目的观察瓣膜手术同期行射频消融迷宫手术治疗心房颤动的疗效,探讨外科手术治疗瓣膜病合并心房颤动的临床价值。方法2003年1月至2011年12月,149例心脏瓣膜病合并心房颤动患者接受瓣膜手术同期行射频消融迷宫手术。记录心电图变化,比较术前与术后心脏超声心动图指标（LAD、LVDS、EF）的变化及心脏功能的恢复情况。随访6～90个月。结果二尖瓣成形术21例,二尖瓣置换术89例（其中生物瓣置换术35例）,主动脉瓣置换术32例（其中生物瓣置换术11例）,三尖瓣成形术46例,三尖瓣置换术3例,左房血栓清除术48例。体外循环时间（82．1±17．8）min,主动脉阻断时间（37．8±25.3）min。双极射频消融121例,单、双极联合射频消融28例,射频消融时间12-38（17．4±5．1）min。手术后即刻,心房颤动全部消失,窦性心律133例,节性心律14例,Ⅲ度房室传导阻滞2例。围术期死亡3例,死亡率2．0％（3／149）,其中2例为严重低心排综合征,1例多器官功能衰竭。术后1个月,窦性心律121例（82．9％）,结性心律8例（5．5％）,心房扑动5例（3．4％）,房颤心律12例（8．2％）,Ⅲ度房室传导阻滞1例（0．6％）,安置永久起搏器。随访时间3～90个月,随访率78．8％（115／146）。随访期间死亡9例（4例心源性死亡,2例脑梗塞死亡,3例脑出血死亡）。106例随访到的存活病例,93例恢复窦性心律,转复率87．7％。随访超声心动图可见左心房及左心室舒张末内径均较术前减小,而左心室射血分数较术前无明显变化。结论瓣膜病合并心房颤动同期行瓣膜手术及射频消融迷宫手术,手术安全性高,远期疗效确切。抗凝并发症仍是瓣膜置换手术远期的主要并发症及致死原因之一,瓣膜成形或生物瓣置换联合射频迷宫手术可能降低此风险。     

心脏瓣膜置换同期射频消融迷宫术治疗心房颤动的手术配合

广东省心血管病研究所手术室自2003年7月～2008年4月在瓣膜置换术同时行单极冲洗射频消融治疗心房颤动(房颤)66例,现将护士术中配合总结如下。1资料和方法1.1临床资料房颤66例,男24例,女42例;年龄24～67岁;心     

导管迷宫射频消融治疗心房颤动的研究

为探索导管迷宫射频电消融（MPRFCA）治疗心房颤动（房颤）的方法，随机选择7条犬，正中线开胸后在右心房外膜上放置5％氯化乙酰胆碱小棉球，1min后用无齿镊轻夹心房诱发持续性房颤（持续时间＞20min），所有犬MPRFCA术前房颤平均持续1516±509s。参考外科迷宫术设计MPRFCA靶图，在双侧心房的5个部位用射频能量（30W，持续30s）产生彼此分离的5条线性透壁性损伤，每条犬完成MPRFCA分割后重复用乙酰胆碱诱发房颤，其持续时间明显缩短（平均324±209s），与术前比较差异有极显著意义。提示MPRFCA术可明显缩短房颤的持续时间，消除持续性房颤的发生。     

49例双极射频消融改良迷宫手术治疗心脏病合并心房纤颤

目的 探讨心脏手术同期进行双极射频改良迷宫手术（Cox maze Ⅲ）治疗心房颤动（AF）的手术效果,研究术后窦性心律维持率及其与左心房大小的关系.方法 2008年4月至2010年6月心脏病合并AF的患者接受心脏手术,同期行房颤改良双极射频消融手术,比较手术前后心电图前后心电图、超声心动图各项指标及心功能变化.结果 全组无手术死亡,术后低心排除量综合征1例,频发室性早搏并短阵室性心动过速2例.全部患者顺利出院.术后失访1例,1例于术后6个月死于栓塞.47例随访存活者,随访3～29个月,3个月、6个月和1年以上稳定窦性心律分别为36/48（75.0%）、36/40（90.0%）和20/22（90.9%）,心功能（NYHA）Ⅰ级41例、Ⅱ级6例,超声显示左房明显缩小.结论 心脏手术中行Cox maze Ⅲ治疗AF安全有效,临床效果良好.随着术后时间延长,稳定窦性心律逐步增加,左房≤60 mm者窦性心律维持率高于≥60 mm者.     

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。     

心内直视下射频消融左心房后壁治疗风湿性心脏病慢性心房颤动的临床研究

目的 　 探讨心瓣膜置换手术过程中心内直视下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 )的可行性及临床疗效。　方法　选择风心病伴慢性房颤患者 38例 ,房颤持续时间 (2 91± 6 4 2 )年 ,于瓣膜置换术中在心内直视下射频消融左心房后壁 ,即运用自制射频消融探针做围绕 4个肺静脉口的环形消融线及连接消融环最低点与二尖瓣环的消融线 ,输出功率 30～ 4 0W ,每次放电时间 4 5～ 6 0s;同时应用胺碘酮 3个月辅助治疗。　结果　消融时间为 (10± 4 )min ,无相关并发症。术后心脏复跳时 35例 (92 1% )为窦性心律 ,3例为房颤 ,其中 2例于 2 4h内转为窦性心律 ,另 1例随访至今仍为房颤 ;住院期间有 2例房颤复发 ,出院后 1个月左右又有 3例房颤复发 ,其余 32例按计划服用胺碘酮满 3个月后停药 ,随访 6～ 2 2 (13± 6 )个月无房颤复发。总成功率 84 2 %(32 / 38)。　结论　心内直视下射频消融左心房后壁治疗风心病慢性房颤有较高的疗效 ,且方法简单 ,并发症少 ;术后应用胺碘酮能辅助逆转心房电重构 ,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。     

Initial experience with a modified left atrial maze procedure concomitant to cardiac surgery

Summary Background: The excellent results of the Cox-Maze-III operation showed that a surgical treatment of atrial fibrillation is possible. The maze operation is surgically demanding and time-consuming. This fact led to the development of simplified modifications. Due to the good results of an exclusive left atrial maze procedure in combination with mitral valve surgery and new technologies of ablation, it seems reasonable to perform these techniques concomitant to cardiac surgery on a large number of patients.?   Methods: From November 1999 until June 2000 a modified maze procedure concomitant to a cardiac surgical intervention was performed on 42 patients, with a mean age of 62.2 years, suffering from chronic or intermittent atrial fibrillation. Primary cardiac disease was mainly cardiac valve disease (mitral valve disease 19 patients, aortic valve disease 10 patients) or coronary heart disease (8 patients). After left atriotomy and with the use of the Thermaline probe (Boston Scientific, Corporation, San Jose, California, USA) a bilateral pulmonary veins isolation was carried out by radiofrequency ablation. An additional ablation line was directed from the left pulmonary veins to the posterior mitral valve anulus. Finally, the left atrial appendage was resected. An evaluation of the therapeutic success was carried out in the immediate postoperative course and 3 months after surgery, at that point of time operation-related influences on the refractory period of the atrial myocardium were negligible.?   Results: At the time of discharge 32 patients (76.2%) showed a regular supraventricular rhythm. Twenty-one patients have already undergone the 3-month follow-up examination. At the time of discharge 13 out of these 21 patients (61.9%) were in sinus rhythm and at 3 months after surgery 18 out of these 21 patients (85.7%) showed a sinus rhythm with a restoration of atrial transport function echocardiographically determined. Three patients were still receiving antiarrhythmic medication.?   Conclusion: The modified maze procedure in combination with cardiac surgical interventions proved to be easy, quick and reliable to perform. The early results suggest a high success rate of this technique. The long-term results have to be verified with further, regular follow-up examinations of the patients. Received: 28 July 2000/Accepted: 30 October 2000     

Radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery

Background

Atrial fibrillation is found in an increasing number of patients undergoing open heart surgery. It is associated with higher mortality rates, risk of stroke and left ventricular dysfunction. Surgical ablation for atrial fibrillation has evolved from the complex“cut and sew” Maze procedure to less invasive techniques, utilizing alternative energy sources. We present our experience with left atrial radiofrequency ablation during cardiac surgery, outlining the technical aspects of the procedure and postoperative outcomes, with emphasis on mid-term freedom from atrial fibrillation.

Methods

The study included 93 consecutive patients with history of atrial fibrillation scheduled for cardiac surgery between January 2008 and December 2011. Concomitant left atrial radiofrequency ablation was performed using monopolar (endocardial) or bipolar (epicardial) systems, depending on the type of underlying cardiac pathology. Duration of the atrial fibrillation, re-do surgery, low ejection fraction, advanced age, or giant left atria were not considered as contraindications.

Results

Of the included patients, 73.1?% were discharged in stable sinus rhythm. Overall freedom from atrial fibrillation was 69.6?% at late follow-up, which ranged from 12 to 48 months (median, 22 months) and did not differ for the two approaches (epicardial vs. endocardial). The presence of early atrial tachyarrhythmia was a predictor of atrial fibrillation recurrence (p?=?0.026). Age was also associated with higher recurrence rates during hospital stay (p?=?0.04), but not for late atrial fibrillation.

Conclusion

Concomitant left atrial radiofrequency ablation conveyed satisfactory early and mid-term rhythm control, with acceptable postoperative outcomes, given the risk profile of our patient cohort.     

Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery

BACKGROUND: The radiofrequency (RF) maze procedure can effectively restore sinus rhythm and atrial transport function in the majority of patients with permanent atrial fibrillation (AF) and mitral valve disease. No previous study has described a cutoff value of preoperative atrial size determined by the discriminant analysis in predicting the success of sinus conversion by the RF maze procedure for permanent AF in patients with mitral valve disease. METHODS AND RESULTS: This study included 81 patients with permanent AF and mitral valve disease who underwent the RF maze IV procedure while undergoing concomitant valvular operations. There was one surgical death (1.2%). Another patient died of acute necrotizing pancreatitis 13 months later. Two patients (2.5%) developed sick sinus syndrome and received transvenous permanent pacemaker implantation. In the remaining 77 patients, there were 38 men and 39 women, with a mean (+/- SD) age of 51 +/- 11 years. At a mean follow-up time of 38 months, 65 patients (84.4%) had persistent sinus conversion that had been accomplished by the RF maze procedure (group 1), and 12 patients (15.6%) did not regain sinus rhythm (group 2). We evaluated the preoperative variables between the two groups. Univariate analysis demonstrated that the preoperative left atrial area and the left atrial diameter of group 1 patients were significantly smaller than those of group 2 patients. Group 1 had significantly fewer patients associated with tricuspid valve disease than did group 2. By multiple stepwise logistic regression analysis, only the preoperative left atrial area was an independent determinant of sinus conversion by the RF maze procedure (odds ratio, 0.961; 95% confidence interval, 0.935 to 0.988; p < 0.005). Linear discriminant analysis demonstrated that the sensitivity and specificity of the cutoff value of 56.25 cm(2) of the preoperative left atrial area in predicting the sinus conversion by the RF maze procedure were 50.0% and 86.2%, respectively, and the positive and negative predictive values were 40.0% and 90.3%, respectively. CONCLUSION: The preoperative left atrial area is an independent determinant of sinus conversion by the RF maze procedure for patients with permanent AF and mitral valve disease.     

Mitral valve surgery with concomitant treatment of atrial fibrillation

Recovery of sinus rhythm after mitral valve surgery in patients with chronic atrial fibrillation lowers thromboembolic risk and improves survival and quality of life. This article reviews the principal surgical procedures devised in the 1980s and 1990s to treat atrial fibrillation during mitral valve operations. Advantages and drawbacks of the different techniques are discussed. Traditional atrial fibrillation surgery is technically demanding and increases operative morbidity. Simplified techniques, mostly limited to the left atrium, have been developed to reduce operation time and procedure-related complications. Intraoperative radiofrequency ablation has recently proven extremely effective in atrial fibrillation surgery, allowing a further simplification of the procedures. We report the results of an original technique for atrial fibrillation treatment during mitral valve surgery through epicardial radiofrequency ablation. Based on recently reported results of atrial fibrillation surgery and on prognostic considerations, specific treatment of both chronic and paroxysmal atrial fibrillation is indicated in virtually all affected patients undergoing mitral valve surgery.     

二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动

目的报告二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动。方法2003年5月至2006年4月83例二尖瓣置换手术患者接受了术中盐水冲洗的射频改良迷宫手术,本组患者中男性23例、女性60例,年龄23～65(46±12)岁,二尖瓣狭窄49例、二尖瓣反流6例、二尖瓣双病变28例,心功能(NYHA分级)Ⅳ级7例、Ⅲ级76例,心房颤动持续时间0．5-18．0(5．4±4．0)年。手术采用Cardioblate系统,射频能量25～30 W,盐水冲洗速度180～240 ml／h。在完成右心房主要的切口及消融后阻断主动脉,经房间隔后左心房切口或房间隔切口施行左心房消融、二尖瓣置换及其他所需的手术,复跳后再完成右心房余下的消融及切口。术后常规使用胺碘酮,定期随访。结果术后围术期死亡2例(机械瓣故障1例,多器官衰竭1例)。体外循环时间70～160(101±26)min,主动脉阻断时间32～106(61±22)min,射频消融时间4～23(11±6)min。随访过程中猝死2例,失访2例。62例患者术后随访1年以上,其中53例恢复窦性心律(85％,53／62)。结论二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗持续心房颤动是合理及有效的。     

Clinical determinants of sinus conversion by radiofrequency maze procedure for persistent atrial fibrillation in patients undergoing concomitant mitral valvular surgery

The radiofrequency Maze procedure can effectively restore sinus rhythm in most patients with atrial fibrillation (AF) and mitral valve disease. AF after cardiac surgery is associated with increased morbidity and mortality. However, clinical determinants of long-term postoperative AF after the radiofrequency Maze procedure and concomitant mitral valve surgery are poorly defined. This study comprised 99 consecutive patients with persistent AF and mitral valve disease who underwent radiofrequency Maze procedures and concomitant mitral valvular operations. The predictive values of clinical variables for postoperative AF were examined. After a mean follow-up period of 46.1+/-24.6 months, 83 patients (83.8%) had sinus conversion after the Maze procedure, and 16 patients remained in persistent or paroxysmal AF. Multiple logistic regression analysis determined that predictors of sinus conversion were preoperative left atrial diameter (odds ratio [OR] 1.127 per 1-mm increment in left atrial diameter, 95% confidence interval [CI] 1.045 to 1.215, p<0.002) and the duration of AF (OR 1.022 per 1-month increment in duration of AF, 95% CI 1.009 to 1.035, p<0.001). Discriminant analysis showed that the sinus conversion rate was significantly lower in patients with preoperative left atrial diameters>56.8 mm (p<0.001) or AF duration>66 months (p<0.001) than in patients with preoperative left atrial diameters<56.8 mm or AF duration<66 months. In conclusion, the preoperative left atrial size and duration of AF are primary predictors of sinus conversion by the radiofrequency Maze procedure for patients with persistent AF and mitral valve disease.