微创迷宫术射频消融治疗风湿性心脏病心房颤动的临床研究

探讨直视下微创迷宫术射频消融左房后壁治疗风湿性心脏病心房颤动 (简称房颤 )的可行性及临床疗效。选择风湿性心瓣膜病伴房颤患者 1 6例 ,阵发性房颤 1例、持续性房颤 1 5例 ,房颤时间 1～ 1 0年 ,在瓣膜置换术中行直视下微创迷宫术射频消融左房后壁 ,即运用射频探针做围绕 4个肺静脉口的环形线性消融及连接消融环最低点与二尖瓣环的直线消融 ,输出功率 30～ 40W ,每次放电时间 45～ 60s ;同时应用胺碘酮辅助治疗 ;随访 6～ 1 2个月。结果显示 :1例手术失败 ,术后早期房颤复发 ;2例出院后房颤复发 ;1 5例持续性房颤患者中有 1 2例能够维持窦性心律 ,成功率 80 %。结论 :微创迷宫术射频消融左房后壁治疗风湿性心脏病房颤有较高的疗效 ,且方法简单 ,并发症少 ;同时应用胺碘酮能逆转心房电重构 ,减少房颤复发

Microtrauma Maze Procedure Radiofrequency Ablation in Patients With Chronic Atrial Fibrillation Undergoing Valvular Heart Surgery

To evaluate whether a microtrauma maze procedure by radiofrequency ablat ion of the posterior region of the left atrium was safe and effective in the cur e of atrial fibrillation (AF) in patients with rheumatic valvular disease,sixtee n patients with AF (1 paroxysmal AF,15 perpetual or chronic AF,it continued for 1 to 10 years) were chosen to performed the microtrauma maze procedure by radiof requency ablation in the posterior region of the left atrium when they underwent the heart valvular surgery and,2 lines of ablation were planned,the one was a r ing to circle the four pulmonary veins and the another was a straight line from the lower most point on the ring to the posterior mitral annulus,the radiofrequency output was 30～40 W and the ablation period was 45～60 s a time.At same time,al l the patients were gaven amiodarone,follow-up survey for 3 to 12 months.Result :12 of 15 patients with perpetual AF can maintain sinus rhythm(80%),and AF relap sed in 3 patients:1 at second day for the ablation failed of success and 2 in tw o months later because stopping administration of amiodarone.Conclusions:The mic rotrauma maze procedure by radiofrequency ablation of posterior left atrium for treating AF with rheumatic valvular disease is safe and effective.Amiodarone was administered to help the maintenance of sinus rhythm and reduce the recurrence of AF.