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目的 探讨心瓣膜置换手术过程中心内直视下射频消融左心房后壁治疗风湿性心脏病(风心病 )慢性心房颤动 (房颤 )的可行性及临床疗效。 方法 选择风心病伴慢性房颤患者 38例 ,房颤持续时间 (2 91± 6 4 2 )年 ,于瓣膜置换术中在心内直视下射频消融左心房后壁 ,即运用自制射频消融探针做围绕 4个肺静脉口的环形消融线及连接消融环最低点与二尖瓣环的消融线 ,输出功率 30～ 4 0W ,每次放电时间 4 5～ 6 0s;同时应用胺碘酮 3个月辅助治疗。 结果 消融时间为 (10± 4 )min ,无相关并发症。术后心脏复跳时 35例 (92 1% )为窦性心律 ,3例为房颤 ,其中 2例于 2 4h内转为窦性心律 ,另 1例随访至今仍为房颤 ;住院期间有 2例房颤复发 ,出院后 1个月左右又有 3例房颤复发 ,其余 32例按计划服用胺碘酮满 3个月后停药 ,随访 6～ 2 2 (13± 6 )个月无房颤复发。总成功率 84 2 %(32 / 38)。 结论 心内直视下射频消融左心房后壁治疗风心病慢性房颤有较高的疗效 ,且方法简单 ,并发症少 ;术后应用胺碘酮能辅助逆转心房电重构 ,减少房颤复发。
Objective To investigate the feasibility and clinical efficacy of radiofrequency ablation of the left atrium posterior wall in the treatment of rheumatic heart disease (rheumatic heart disease) chronic atrial fibrillation (AF) undergoing open heart surgery under cardiac valve replacement surgery. Methods 38 cases of patients with rheumatic heart disease and chronic atrial fibrillation were enrolled. The duration of atrial fibrillation was (291 ± 642) years. During the procedure of valve replacement, left atrial posterior wall was radiofrequency ablated under open heart surgery. To do around the four pulmonary vein ablation ring and the ablation line and the lowest point of the mitral annulus ablation line, the output power of 30 ~ 40W, each discharge time 45 ~ 60s; the same time, amiodarone 3 months Assisted treatment. Results The ablation time was (10 ± 4) min with no complications. 35 cases (92.1%) had sinus rhythm after cardiopulmonary resuscitation, 3 cases were atrial fibrillation, 2 cases were converted to sinus rhythm within 24 hours, and the other cases were still atrial fibrillation after follow-up. During hospitalization 2 cases of atrial fibrillation recurrence, 1 month after discharge about 3 cases of atrial fibrillation recurrence, the remaining 32 patients scheduled for amiodarone over three months after stopping, followed up for 6 ~ 2 2 (13 ± 6) months Atrial fibrillation recurrence. Assembly success rate 84 2% (32/38). Conclusions Radiofrequency catheter ablation of the left atrium posterior wall in patients with rheumatic heart disease undergoing open heart surgery has a higher efficacy and is simple in procedure and less in complications. Amiodarone can reverse the atrial electrical remodeling and reduce the recurrence of atrial fibrillation .