改良沖洗式雙極射頻消融手術治療心房顫動_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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徐盛松 , 石開虎

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Keywords：

心房顫動; 　心臟外科手術; 　射頻消融

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目的　分析心瓣膜置換術中同期行改良沖洗式雙極射頻消融治療心房顫動的臨床效果。　方法　回顧性分析2009年4月至2011年6月安徽醫科大學第二附屬醫院心瓣膜病合并心房顫動34例患者在體外循環下行心瓣膜置換術＋改良沖洗式雙極射頻消融手術的臨床資料，其中男21例，女13例；年齡41～76 （50.5±11.3）歲。風濕性心臟瓣膜病31例，心瓣膜退行性病變3例；合并慢性持續性/永久性心房顫動27例，陣發性心房顫動7例。均采用Medtronic Cardioblate 68000沖洗式雙極射頻消融系統進行消融操作。消融手術包括雙側肺靜脈的環形隔離、左心耳切除、左右心房消融（改良Cox-mazeⅢ手術路徑）和Marshall韌帶切除。術后常規予胺碘酮治療。　結果　全組無死亡，除2例術后并發Ⅲ○房室傳導阻滯、安裝永久性心臟起搏器外，其余患者未發生與消融相關的并發癥。術后31例轉為非心房顫動心律（竇性心律25例，結性心律4例，起搏心律2例），3例維持心房顫動心律。隨訪3～20個月，29例維持竇性心律(85.3%)，3例心房顫動心律，2例起搏心律。　結論　改良沖洗式雙極射頻消融治療心房顫動安全、有效。

Citation： 徐盛松,石開虎. 改良沖洗式雙極射頻消融手術治療心房顫動. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 440-441. doi: Copy

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6.	Vicol C， Kellerer D， Petrakopoulou P， et al. Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease：is microwave energy reliable? J Thorac　Cardiovasc Surg， 2008， 136 （5）：1156-1159.
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1. 　Fuster V， Rydén LE， Cannom DS， et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines （Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation）. Eur Heart J， 2006， 27 （16）：1979-2030.
2. 　王堅剛，孟旭，李暉，等. 心內膜合并心外膜改良迷宮射頻消融治療心房纖顫．中華外科雜志， 2007， 45 （6）：415-418．.
3. 　Marui A， Saji Y， Nishina T， et al. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function. J Thorac Cardiovasc Surg， 2008， 135 （6）：1297-1305.
4. 　Deneke T， Khargi K， Lemke B， et al. Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation. Eur Heart J， 2007， 28 （23）：2909-2914.
5. 　Albrecht A， Kalil RA， Schuch L， et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg， 2009， 138 （2）：454-459.
6. 　Vicol C， Kellerer D， Petrakopoulou P， et al. Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease：is microwave energy reliable? J Thorac　Cardiovasc Surg， 2008， 136 （5）：1156-1159.
7. 　Beyer E， Lee R， Lam BK. Point：minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation：early multicenter results. J Thorac　Cardiovasc Surg， 2009， 137 （3）：521-526.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

改良沖洗式雙極射頻消融手術治療心房顫動

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