双极射频消融迷宫术在治疗风湿性心脏瓣膜病合并心房颤动中的疗效观察

目的 探讨风湿性心脏瓣膜病合并心房颤动患者在行瓣膜替换术的同时行双极射频消融迷宫术的疗效.方法 选取风湿性心脏瓣膜病合并心房颤动患者15例(治疗组),在行瓣膜替换术的同时行双极射频消融迷宫术治疗心房颤动.同期随机选择15例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.对两组患者的治疗结果进行比较.结果 治疗组15例患者术后全部恢复窦性心律.随访6个月,14例维持窦性心律,1例偶发阵发性心房颤动.对照组13例术中心脏复跳后即为心房颤动心律,2例心脏复跳后为窦性心律,分别在术后1、2 d后转为心房颤动心律,应用胺碘酮均不能恢复窦性心律.两组术后左房内径、左室收缩末期内径、左室舒张末期内径、心胸比率均较术前显著降低(P＜0.01),左室射血分数较术前显著增加(P＜0.05).治疗组术后左房内径及心胸比率显著低于对照组术后[(31.06±2.28)mm比(36.16±2.23)mm,t=11.645,P=0.002;(50±9)%比(56±10)%,t=8.052,P=0.008].结论 风湿性心脏瓣膜病合并心房颤动患者在行瓣膜替换术的同时行双极射频消融迷宫术疗效较好,操作简便,耗时短.

Observation of bipolar radiofrequency ablation maze procedure treating atrial fibrillation

Objective To observe the bipolar radiofrequency ablation maze procedure (BRAMP) combined with heart valve replacement for rheumatic heart disease (RHD) complicated with atrial fibrillation (AF), and discuss the curative effect of the new operation method. Methods Fifteen patients with RHD complicated with AF were treated with heart valve replacement and BRAMP (treatment group). At the same time, 15 patients with RHD complicated with AF were only heart valve replacement without BR AMP(control group). Results Treatment group were all cured, and they had the sinoatrial rhythm after operation.Followed up 6 months, 14 patients maintained sinus rhythm,one had AF occasionally. In control group, 13 patients had AF after operation,2 patients had the sinoatrial rhythm after operation, but they tumed to AF one or two days later,and amiodarone hydrochloride had no effect to them. The two groups had obvious differences in the length of left atria, the length of left ventricle, the size of the heart, the function of the heart and LVEF before and after operation (P ＜ 0.01 or ＜ 0.05). But in treatment group, the length of left atria and the size of the heart had obvious difference after operation compared with control group [ (31.06 ± 2.28 ) mm vs. (36.16 ±2.23) mm,t = 11.645,P =0.002; (50 ±9)% vs. (56 ± 10)% ,t =8.052,P =0.008].Conclusion Compared with the operation that heart valve replacement without BRAMP,BRAMP is simple and little, should be promising.