非体外循环冠状动脉旁路移植术同期行心房颤动双极射频消融术

目的总结借助瑞克Ⅲ心脏固定器在非体外循环冠状动脉旁路移植术同期行双极心房颤动（房颤）射频消融术的手术效果。方法2008年1月至2013年10月北京安贞医院共有49例冠心病合并房颤患者接受非体外循环冠状动脉旁路移植术（OPCAB）加Atricure双极射频消融术。根据房颤的持续时间不同，将49例患者分为两组，持续性房颤组（A组）：14例，男9例、女5例，年龄（56．7±7．5）岁；阵发性房颤组（B组）：35例，男27例、女8例，年龄（60．2±10．5）岁。房颤病程为（9．4±6．0）个月。冠状动脉狭窄85％～100％。术后随访行动态心电图及超声心动图检查，观察房颤是否再发。结果无术中转为体外循环手术患者，围手术期无死亡。术后当天有81．6％的患者（40／49）转为窦性心律或交界性心律，18．4％的患者（9／49）仍为房颤心律，未出现Ⅱ～Ⅲ度房室传导阻滞。全组搭桥139支，平均2．8支。住院时间10～15（12±3）d。出院时患者维持窦性心律34例（69％），其中A组9例（64％），B组25例（71％）。所有患者均得到随访，随访率100％，随访时间5～12个月。维持窦性心律6个月以上39例（80％），其中A组10例（71％），B组29例（83％）；术后12个月窦性心律44例（90％），A组11例（79％），B组33例（94％）。两组差异无统计学意义（P〉0．05）。结论借助瑞克Ⅲ心脏固定器，在心脏不停跳冠状动脉旁路移植术同期行双极房颤消融手术是安全、有效、可行的。

Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation

Olajective To evaluate surgical outcomes ot combined oil：pump coronary artery bypass grafting（ OPCAB） and bipolar radiofrequency ablation （RFA） for atrial fibrillation （AF）. Methods From January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2± 10.5 years. AF duration was 9.4± 6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. Results None of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% （40/49）patients had conversion to sinus rhythm （SR） or junctional rhythm, 18.4% （9/49） patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 （ 12 ± 3 ） days. SR was observed in 34 patients （69%） before discharge including 9 patients （64%） in group A and 25 patients （ 71%） in group B. All the patients （100%） were followed upfor 5-12 months. 39 patients （80%） maintained SR over 6 months, including 10 patients （71%） in group A and 29 patients （83%） in group B. 44 patients （90%） maintained SR over 12 months, including 11 patients （79%） in group A and 33 patients （94%） in group B. There was no statistical difference in SR maintenance rate between the 2 groups （P 〉 0.05）. Conclusion OPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.