心脏瓣膜置换同期行双极射频消融术治疗房颤的疗效及安全性探讨

目的观察在心脏瓣膜置换术中同期行双极射频消融术治疗心房颤动（AF）的疗效及安全性。方法回顾性分析自2007年4月至2010年8月在瓣膜置换术同期行双极射频消融术治疗AF患者70例的临床资料。全组在全麻开胸直视体外循环下行双极射频消融术＋瓣膜置换术。结果70例患者全部存活，术后当天心电图提示：64例患者心律均由AF转为窦性心律，3例结性心律，2例顽固室性心动过速，1例Ⅲ度房室传导阻滞。随访3～40个月无一例死亡，61例维持窦性心律，占87．1％；6例房颤心律，占8．6％；3例房扑心律，占4．3％。结论双极射频消融术治疗RHD合并AF，可使绝大多数病人恢复窦性心律，是一种安全的值得推广的好方法。

Ablation treatment for atrial fibrillation in heart valve replacement surgery

Objective To observe effect and safety of bipolar radiofrequency ablation for atrial fi- brillation （AF） in the course of heart valve replacement. Methods Retrospectively analyze the clinical data from April 2007 to August 2010, 70 cases of rheumatic heart disease （RHD） with AF received bipolar radiofrequency ablation for atrial fibrillation （AF） in the course of heart valve replacement. There were 24 Male and 46 female. The age ranges was from 28 years to 69 years. Among them, Mitral valve replacement was 25 cases, Aortic valve replacement was 5 cases, Mitral and aortic valve re- placement was 32 cases, and mitral and aortic and tricuspid valve replacement was 8 cases. Results There were no perioperational mortality. The follow-up ranging was from 3 months to 40 months, patients were survived after operation, the postoperative complications acute cardiac perforation/pressure plugl case, coronary artery ischemia 2 cases. The electrocardiogram was represented that the cardiac rhythm of 61 patients turn from AF to sinus rhythm, 3 cases were nodal rhythm, 2 cases were stub- born ventricular tachycardia. 1 case was ]]] atrioventricular block. In the following 3~40 months, there was no death. 61 cases kept sinus rhythm and were account for 87.1%. Six cases were atrial fibrillation rhythm were 8.6%. 3 cases were atrial flutter rhythm and accounted for 4.3 %. Conclusion Bipolar radiofrequency ablation for atrial fibrillation （AF） in the course of heart valve replacement is a safe and effective therapeutic method.