改良冲洗式双极射频消融手术治疗心房颤动_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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徐盛松 , 石开虎

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Keywords：

心房颤动; 　心脏外科手术; 　射频消融

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目的　分析心瓣膜置换术中同期行改良冲洗式双极射频消融治疗心房颤动的临床效果。　方法　回顾性分析2009年4月至2011年6月安徽医科大学第二附属医院心瓣膜病合并心房颤动34例患者在体外循环下行心瓣膜置换术＋改良冲洗式双极射频消融手术的临床资料，其中男21例，女13例；年龄41～76 （50.5±11.3）岁。风湿性心脏瓣膜病31例，心瓣膜退行性病变3例；合并慢性持续性/永久性心房颤动27例，阵发性心房颤动7例。均采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融操作。消融手术包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融（改良Cox-mazeⅢ手术路径）和Marshall韧带切除。术后常规予胺碘酮治疗。　结果　全组无死亡，除2例术后并发Ⅲ○房室传导阻滞、安装永久性心脏起搏器外，其余患者未发生与消融相关的并发症。术后31例转为非心房颤动心律（窦性心律25例，结性心律4例，起搏心律2例），3例维持心房颤动心律。随访3～20个月，29例维持窦性心律(85.3%)，3例心房颤动心律，2例起搏心律。　结论　改良冲洗式双极射频消融治疗心房颤动安全、有效。

Citation： 徐盛松,石开虎. 改良冲洗式双极射频消融手术治疗心房颤动. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 440-441. doi: Copy

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1. 　Fuster V， Rydén LE， Cannom DS， et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines （Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation）. Eur Heart J， 2006， 27 （16）：1979-2030.
2. 　王坚刚，孟旭，李晖，等. 心内膜合并心外膜改良迷宫射频消融治疗心房纤颤．中华外科杂志， 2007， 45 （6）：415-418．.
3. 　Marui A， Saji Y， Nishina T， et al. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function. J Thorac Cardiovasc Surg， 2008， 135 （6）：1297-1305.
4. 　Deneke T， Khargi K， Lemke B， et al. Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation. Eur Heart J， 2007， 28 （23）：2909-2914.
5. 　Albrecht A， Kalil RA， Schuch L， et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg， 2009， 138 （2）：454-459.
6. 　Vicol C， Kellerer D， Petrakopoulou P， et al. Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease：is microwave energy reliable? J Thorac　Cardiovasc Surg， 2008， 136 （5）：1156-1159.
7. 　Beyer E， Lee R， Lam BK. Point：minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation：early multicenter results. J Thorac　Cardiovasc Surg， 2009， 137 （3）：521-526.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

改良冲洗式双极射频消融手术治疗心房颤动

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