CAJ | 학술논문

目的总结应用双极射频消融术在心外科手术同期治疗房颤的疗效,探讨房颤近期疗效的影响因素.方法 2007年6月至2010年2月,81例房颤患者被纳入研究.其中男45例,女36例；年龄(48.2±11.0)岁.合并先天性心脏病8例,冠心病16例,风湿性心脏病57例.房颤持续(7.56±7.47)年,其中永久性房颤26例,持续性房颤44例,阵发性房颤11例.左房直径36～ 72mm,其中小于60 mm者65例.术前心功能Ⅱ-Ⅳ级.应用Atricure双极消融系统49例,Metronic单双极消融系统32例.2009年6月至2010年2月期间22例患者进行房颤标测.所有患者均按照迷宫IV径路行双极房颤射频消融手术,同期行非体外循环冠状动脉旁路移植术(OPCAB) 16例,二尖瓣置换术(MVR)[或+三尖瓣成形术(TVP) ]33例,MVR+冠状动脉旁路移植术(CABG)1例,二尖瓣成形术(MVP)1例,主动脉瓣置换术(AVR)4例,二尖瓣主动脉瓣置换术(DVR)(或+TVP)18例,先心纠治8例.术后随访12 ～44个月.结果住院期间死亡1例,无远期死亡.体外循环(105.0±26.9) min,主动脉阻断(64.1±21.4) min(OPCAB病例除外).术后即刻、出院时及平均随访(26.1±13.6)个月时房颤消融成功率分别为100％、82.5％及84.8％.左房内径小于60mm、房颤标测患者消融成功率显著提高(P＜0.05).结论心外科手术同期行双极房颤射频消融术是安全有效的.左房内径小于60 mm、房颤标测为影响房颤近期疗效的独立影响因素,可能带来更佳的消融结果.
목적 총결응용쌍겁사빈소융술재심외과수술동기치료방전적료효,탐토방전근기료효적영향인소.방법 2007년6월지2010년2월,81례방전환자피납입연구.기중남45례,녀36례；년령(48.2±11.0)세.합병선천성심장병8례,관심병16례,풍습성심장병57례.방전지속(7.56±7.47)년,기중영구성방전26례,지속성방전44례,진발성방전11례.좌방직경36～ 72mm,기중소우60 mm자65례.술전심공능Ⅱ-Ⅳ급.응용Atricure쌍겁소융계통49례,Metronic단쌍겁소융계통32례.2009년6월지2010년2월기간22례환자진행방전표측.소유환자균안조미궁IV경로행쌍겁방전사빈소융수술,동기행비체외순배관상동맥방로이식술(OPCAB) 16례,이첨판치환술(MVR)[혹+삼첨판성형술(TVP) ]33례,MVR+관상동맥방로이식술(CABG)1례,이첨판성형술(MVP)1례,주동맥판치환술(AVR)4례,이첨판주동맥판치환술(DVR)(혹+TVP)18례,선심규치8례.술후수방12 ～44개월.결과 주원기간사망1례,무원기사망.체외순배(105.0±26.9) min,주동맥조단(64.1±21.4) min(OPCAB병례제외).술후즉각、출원시급평균수방(26.1±13.6)개월시방전소융성공솔분별위100％、82.5％급84.8％.좌방내경소우60mm、방전표측환자소융성공솔현저제고(P＜0.05).결론 심외과수술동기행쌍겁방전사빈소융술시안전유효적.좌방내경소우60 mm、방전표측위영향방전근기료효적독립영향인소,가능대래경가적소융결과.
Objective We sought to evaluate the efficacy of bipolar radiofrequency ablation of atrial fibrillation (AF) in patients undergoing cardiac surgery,and to determine independent factors affecting the recurrence.Methods From June 2007 through February 2010,81 patients with atrial fibrillation underwent a modified Cox-Maze Ⅳ procedure using a biopolar radiofrequency device( Medtronic in 32 cases,Atricure in 49 cases).There were 45 males and 36 females,aged (48.2 ± 11.0)years,including 26 cases of permanent AF,44 cases of persistent AF and 11 cases of paroxysmal AF.The mean duration time of AF was (7.56 ± 7.47 ) years.The left atrial diameter were 36 ～ 72 mm.In conjunction with cardiac surgery including:mitral valve replacement (MVR) (or add tricuspid valve plasty (TVP) in 33 cases,mitral and aortic valve replacement (DVR)( or add TVP) in 18 cases,off-pump coronary artery bypass surgery (OPCAB) in 16 cases,aortic valve replacement (AVR) in 4 cases,MVR and coronary artery bypass grafting (CABG) in 1 case,mitral valve plasty (MVP) in 1 case,and others in 8 cases.Among them,22 patients were undergoing electrophysiological mapping by high-frequency bipolar stimulation from June 2009 to February 2010.A follow-up of 12 to 44 months was completed.Recurrences were evaluated by 12-lead ECG or 24 hour Holter recording every clinic visit-1,3,6,9,and 12 months after the procedure and yearly thereafter,or if symptoms developed.Multivariate regression analysis was performed to determine independent factors affecting the recurrence.Results Hospital mortality was 1.23％.The successful ablation of AF were 100％,82.5％,and 84.8％ immediately after operation,at discharge,and at 2(6.1 ± 13.6) months after operation respectively.Multinomial regression analysis showed small left atrium ( ＜ 60 mm),and electrophysiological mapping might contribute better sinus rhythm restoration ( P ＜ 0.05 ).Conclusion Bipolar radiofrequency ablation of atrial fibrillation in patients undergoing cardiac surgery is safe and effective.Small left atrium ( ＜ 60mm) and electrophysiological mapping should be considered to improve results in selected patients.