CAJ | 학술논문

目的探讨心脏瓣膜病手术患者同期行房颤外科射频消融术后房颤复发的危险因素.方法回顾性分析2010年4月至2012年12月施行瓣膜手术同期行房颤射频消融治疗的255例瓣膜病合并房颤患者,多元回归分析筛选影响房颤复发的独立危险因素.结果术后死亡8例,交界性心律或安装起搏器11例,失访60例,完成随访176例.术后长期心律监测结果示107例患者维持稳定的窦性心律,69例房颤复发.术前较大左心房内径、较高血清B型钠尿肽(BNP)、较慢心率和术后出院前出现房颤心律是术后房颤复发的独立危险因素.结论术后4～ 38个月,平均12个月时,瓣膜病合并房颤患者射频消融治疗效果受术前左心房内径、BNP水平和心率影响;术后出院前出现房颤心律提示预后较差,应予药物或电复律干预.
목적 탐토심장판막병수술환자동기행방전외과사빈소융술후방전복발적위험인소.방법 회고성분석2010년4월지2012년12월시행판막수술동기행방전사빈소융치료적255례판막병합병방전환자,다원회귀분석사선영향방전복발적독립위험인소.결과 술후사망8례,교계성심률혹안장기박기11례,실방60례,완성수방176례.술후장기심률감측결과시107례환자유지은정적두성심률,69례방전복발.술전교대좌심방내경、교고혈청B형납뇨태(BNP)、교만심솔화술후출원전출현방전심률시술후방전복발적독립위험인소.결론 술후4～ 38개월,평균12개월시,판막병합병방전환자사빈소융치료효과수술전좌심방내경、BNP수평화심솔영향;술후출원전출현방전심률제시예후교차,응여약물혹전복률간예.
Objective The purpose of this study was to explore the risk factors of recurrence of atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing cardiac valve surgery.Metbods Retrospective analysis was made in 255 cardiac valve patients undergoing concomitant radiofrequency modified Maze operation from April 2010 to December 2012 in Nanjing Drum Tower Hospital.Multivariate logistic regression analysis was used to screen independent risk factors for predicting recurrence of AF.Results Excluding 8 patients died after surgery,11 cases who were junctional rhythm after ablation or received pacemaker implantation and 60 lost case,176 patients were finished follow-up.107 cases maintained stable sinus rhythm (SR),whereas other 69 cases developed AF recurrence.Multivariate logistic regression analysis found larger left atrial size,higher B-type natriuretic peptide,lower preoperative heart rate and postoperative AF rhythm before discharge were independent risk factors for predicting AF recurrence.Conclusion Larger left atrial size,higher B-type natriuretic peptide and lower preoperative heart rate before surgery can impact outcome of surgical radiofrequency ablation in patients undergoing cardiac valve surgery after following 12(4-38)months.They can be used in clinical practice to choose more suitable cardiac valve patients with AF for surgical ablation.Postoperative appearance of AF rhythm before discharge indicated a poor prognosis,which should be interfered with drugs or electrical cardioversion.