心内直视术中同期射频消融治疗心房纤颤疗效的危险因素分析

目的 总结心内直视术中同期行射频消融（radiofrequencyablation，RFA）治疗心房纤颤（atrialfibrillation，AF）的临床疗效．分析可能影响转复率的危险因素。方法将2009年1月至2011年1月广东省人民医院收治的483例心内直视术同期行RFA的患者全部纳入研究，以术后3个月内是否为持续性AF进行分组比较，对术前、术中、术后可能影响RFA转复效果的相关因素进行单因素和多因素分析。结果左心房内径≥55mm（OR=8．925，95％CI：5．045．15．790，P〈0．0001），年龄≥60岁的患者RFA转复率明显降低（DR=2．940，95％CI：1．731～4．992．P〈O．0001）；接受双心房消融的患者相对于单纯接受左心房消融的患者转复成功率高（OR=0．590，95％CI：0．276～0．961，P=0．0321）。结论左心房≥55mm、年龄≥60岁是影响RFA手术效果的独立危险因素；双心房消融相对于左心房消融治疗效果更好。

Risk factors of the efficacy of concomitant radiofrequency ablation treatment for atrial fibrillation in open cardiac surgery

Objectives To study the clinical outcome of concomitant radiofrequeney ablation （RFA） combined with open cardiac surgery for the treatment of atrial fibrillation （AF）, and analyze the risk factors. Methods Totally 483 patients undergoing concomitant RFA during open cardiac surgery from January 2009 to January 2011 in Guangdong General Hospital were observed. According to whether there was persistent AF in the early stage （within the first 3 months） after operation, the 483 patients were divided into two groups for further analysis on the relative factors before, during and after operation by single factor and multiple factors analysisl Results Patients with left atrium diameter≥55 mm （OR = 8.925, 95%CI： 5.045-15.790,P〈0.0001）or aged≥60 （OR=2.940, 95%CI： 1.731-4.992,P〈0.0001）were of significant lower restoring rates of postoperative atrial fibrillation. Patients received biatrial radiofrequeney ablation had higher restoring rates comparing to those received left atrial radiafreqnency alone （OR =0.590, 95%CI： 0.276-0.961, P=0.0321 ）. Conclusions Left atrial diameter~〉 55 mm and age ≥ 60 are the independent risk factors of the efficacy of radiofrequeney ablation. Efficacy of biatrial radiofrequency ablation is better than that of left atrial radiafrequency ablation.