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。

Application of endocardial microwave ablation for atrial fibrillation in rheumatic heart disease patients undergoing mitral valve replacement

Objective To research endocardial microwave ablation for treatment of persistent atrial fibrillation （AF） while undergoing rheumatic valve replacement. Methods Sixty-six patients with rheumatic mitral lesion were randomly divided into two group. Thirty-three patients received endocardial microwave blation when their mitral valve were replaced, thirty-three patients underwent replacement alone in control group. Results Aortic cross-clamping time and cardiopulmonary bypass time were longer in microwave group than those in control group（63.8 ± 17.8 min vs 47.5 ±18.0 min, 108.9 ± 32.2 min vs 85.3± 22.9 min, all P 〈 0.05）. Both groups had no serious complications after surgery. Followed-up 2.3 ± 1.4 years, 72.7% （24/33） of patients remained sinus rhythm in microwave group and 15.2% （5/33） patients in control group（P 〈0.05 ）. Followed-up 6 months, 2 years, left atrial diameter in microwave group was obviously less than that in control group ; Followed-up 2 years, tricuspid regurgitation in microwave group was significantly lower than that in control group. Conclusion Endocardial microwave ablation of AF during mitral valve replacement is safe and ef- fective, it can delay the progress of postoperative left atrial diameter and tricuspid regurgitation.