CAJ | 학술논문

目的探讨心脏瓣膜置换和心内直视下同期双极射频消融治疗心瓣膜病合并持续性心房颤动的安全性和疗效.方法回顾性分析2010年4月至2013年8月心脏瓣膜病合并持续性心房颤动70例患者行心瓣膜置换术加改良冲洗式双极射频消融手术的临床资料,术中采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融.消融路径包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融和Marshall韧带切除;术后根据病情给予胺碘酮治疗3～6个月.结果 70例患者手术均顺利完成,平均消融时间为(14±6) min,术后当天有62例恢复为窦性心律;其中6例分别于术后2周内发生阵发性心房颤动,经静脉持续泵入盐酸胺碘酮后5例转为窦性心律,1例于出院时仍为心房颤动心律;术后当天仍有6例为房颤心律.全组有2例围手术期出现Ⅲ度房室传导阻滞,出院前安装永久起搏器.全组无心脏穿孔,无手术死亡.患者平均住院时间为(12.3 ±2.1)d.术后平均随访(9±5)个月,术后6个月随访患者有82.8％(58/70)维持窦性心律,14.3％ (10/70)仍为心房颤动,2.9％(2/70)为起搏心律.结论心内直视下同期改良冲洗式双极射频消融治疗心脏瓣膜病合并持续性心房颤动是一种简易、安全、有效的方法.
목적 탐토심장판막치환화심내직시하동기쌍겁사빈소융치료심판막병합병지속성심방전동적안전성화료효.방법 회고성분석2010년4월지2013년8월심장판막병합병지속성심방전동70례환자행심판막치환술가개량충세식쌍겁사빈소융수술적림상자료,술중채용Medtronic Cardioblate 68000충세식쌍겁사빈소융계통진행소융.소융로경포괄쌍측폐정맥적배형격리、좌심이절제、좌우심방소융화Marshall인대절제;술후근거병정급여알전동치료3～6개월.결과 70례환자수술균순리완성,평균소융시간위(14±6) min,술후당천유62례회복위두성심률;기중6례분별우술후2주내발생진발성심방전동,경정맥지속빙입염산알전동후5례전위두성심률,1례우출원시잉위심방전동심률;술후당천잉유6례위방전심률.전조유2례위수술기출현Ⅲ도방실전도조체,출원전안장영구기박기.전조무심장천공,무수술사망.환자평균주원시간위(12.3 ±2.1)d.술후평균수방(9±5)개월,술후6개월수방환자유82.8％(58/70)유지두성심률,14.3％ (10/70)잉위심방전동,2.9％(2/70)위기박심률.결론 심내직시하동기개량충세식쌍겁사빈소융치료심장판막병합병지속성심방전동시일충간역、안전、유효적방법.
Objective To summarize the clinical outcomes of modified maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of persistent atrial fibrillation (AF) and heart valve diseases.Methods A total of 70 patients with persistent AF and heart valves diseases had surgical treatment from April 2010 to August 2013 in the Second Affiliated Hospital of Anhui Medical University,including 42 males and 28 females with age 38-76,average (50 ± 11) years old.Rheumatic heart disease was in 65 cases and 5 cases of them suffered degenerative disease of the heart valves.The Medtronic Cardioblate 68000 flush bipolar radiofrequency ablation system was applied to all patients.Ring RF ablation procedures consisted bilateral pulmonary vein isolation,left atrial appendage resection,left and right atrial ablation (modified Cox-maze Ⅲ surgical path) and Marshall ligament resection.All patients had amiodarone therapy after surgery for 3 to 6 months.Results The surgery of 70 patients was successfully completed.The mean atrial fibrillation duration was (14 ±6) min.All patients took amiodarone hydrochloride after surgery.The day after surgery,62 cases atrial fibrillation rhythm turned into sinus rhythm.Paroxysmal atrial fibrillation occurred in 6 cases two weeks after surgery and 5 cases turned into sinus rhythm after intravenous amiodarone.In all patients,2 of them suffered from Ⅲ° atrioventricular block after surgery and permanent pacemakers were applicated.There were no cardiac perforation and non-hospital mortality.The average hospitalization was (12.3 ± 2.1) d.The mean follow-up was (9 ± 5) months.82.8％ (58/70) of patients had sinus rhythm,14.3％ (10/70) were in AF rhythm and 2.9％ (2/70) in paced rhythm 6 months after operation.Conclusion Modified maze procedure using bipolar radiofrequency ablation is a simple,safe and effective surgical procedure for the treatment of persistent atrial fibrillation.