CAJ | 학술논문

目的探讨65岁以上患者行单极与双极射频消融治疗心房颤动的临床疗效和影响因素. 方法选取我院心外科2008年10月至2013年12月50例器质性心脏病合并心房颤动的老年患者,根据手术方式分为单极射频消融组20例(单极组)和双级射频消融组30例(双极组).术后随访3个月、6个月、12个月,记录心电图,观察窦性心律的转复情况.根据心电图结果,将术后12个月随访患者(43例)分为窦性与非窦性心律组,比较两组相关因素的差异. 结果术后3个月、6个月、12个月窦性心律转复率单极组分别为73.7％(14/19)、66.7％(12/18)、61.1％(11/18),双极组分别为82.8％(24/29)、85.2％(23/27)、88.0％(22/25).两组术后12个月转复率比较,差异有统计学意义(P＜0.05).并发症单极组为55.0％(11例),双极组为26.7％(8例),两组比较差异有统计学意义(P＜0.05).术前心房颤动病史、左心房内径是影响窦性心律转复率的因素(P＜0.05). 结论双极射频消融治疗心房颤动安全性高、并发症少、成功率高.术前心房颤动病史长和左心房大的患者转复率低,且易复发.
목적 탐토65세이상환자행단겁여쌍겁사빈소융치료심방전동적림상료효화영향인소. 방법 선취아원심외과2008년10월지2013년12월50례기질성심장병합병심방전동적노년환자,근거수술방식분위단겁사빈소융조20례(단겁조)화쌍급사빈소융조30례(쌍겁조).술후수방3개월、6개월、12개월,기록심전도,관찰두성심률적전복정황.근거심전도결과,장술후12개월수방환자(43례)분위두성여비두성심률조,비교량조상관인소적차이. 결과 술후3개월、6개월、12개월두성심률전복솔단겁조분별위73.7％(14/19)、66.7％(12/18)、61.1％(11/18),쌍겁조분별위82.8％(24/29)、85.2％(23/27)、88.0％(22/25).량조술후12개월전복솔비교,차이유통계학의의(P＜0.05).병발증단겁조위55.0％(11례),쌍겁조위26.7％(8례),량조비교차이유통계학의의(P＜0.05).술전심방전동병사、좌심방내경시영향두성심률전복솔적인소(P＜0.05). 결론 쌍겁사빈소융치료심방전동안전성고、병발증소、성공솔고.술전심방전동병사장화좌심방대적환자전복솔저,차역복발.
Objective To compare clinical effect of unipolar versus bipolar radiofrequency ablation in treating atrial fibrillation (AF) in elderly patients and discuss the correlated risk factors.Methods From October 2008 to December 2013,a total of 50 elderly patients with organic heart disease and AF underwent radiofrequency ablation surgery.All patients were divided into 2 groups of unipolar (group A,n=20) and bipolar (group B,n=30 patients) radiofrequency ablations.The variations of electrocardiogram (ECG) and ultrasonic cardiogram (UCG) in patients were collected and the complications and the NYHA class of the patients were recorded at 3,6 and 12 months after surgery.The total 43 elderly patients were divided into sinus group and non-sinus group according to their ECG at 12 months after surgery.Results The recovery rates of sinus rhythm at 3,6 and 12 months after surgery were 73.7％(14/19),66.7％(12/18) and 61.1％ (11/18)respectively in group A and 82.8％(24/29),85.2％(23/27)and 88.0％(22/25) respectively in group B.Two groups of the recovery rate of sinus rhythm had a statistically significant difference between the two groups (P＜0.05) at 12 months after surgery.The complication rate in group A was higher than in group B [55.0％ (11 cases) vs.26.7％ (8 cases),P＜0.05].Preoperative history of AF and left atrial diameter were the influencing factors for the sinus rhythm recovery rates (P＜0.05).Conclusions Bipolar radiofrequency ablation for AF is safe and has less complications and high success rate of restoring sinus rhythm.The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm with a high recurrence rate.