>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
改良左房盒式5区法迷宫Ⅳ手术联合胺碘酮对房颤的临床效果
作者:陆启同  刘志勇  蒲振业 
单位:东南大学附属中大医院 胸心外科, 江苏 南京 210009
关键词:心房颤动 射频消融术 改良左房盒式5区法 迷宫Ⅳ术 
分类号:R654.2
出版年·卷·期(页码):2018·37·第六期(956-959)
摘要:

目的:探讨改良左房盒式5区法迷宫Ⅳ术联合胺碘酮对伴有房颤的心脏瓣膜手术患者窦性心律转复的临床效果。方法:对56例心脏瓣膜病合并房颤需要同期手术治疗的患者,在瓣膜置换术同期行改良左房盒式5区法迷宫Ⅳ术。患者中男32例,女24例,年龄41~68岁,房颤病程3~28年,均为长程持续性房颤。患者术后3个月持续服用胺碘酮,出院前及术后每3个月复查心电图。结果:56例患者中49例出院时为窦性节律(87.5%)。无失访出院患者,随访时间6~48个月,最后1次随访时维持窦性节律者45例(80.3%)。结论:心脏瓣膜手术同期对伴有房颤患者行改良左房盒式5区法迷宫Ⅳ术操作简单,效果可靠,术后辅助性应用胺碘酮可达到满意的窦性心律维持率。

Objective:To investigate the clinical effect of modified left atrial box 5 zone maze Ⅳ procedure combined with amiodarone on converting atrial fibrillation to sinus rhythm in valvular heart disease patients with atrial fibrillation. Methods:Fifty-six valvular heart disease patients complicated with long-standing persistent atrial fibrillation were treated with modified left atrial box 5 zone maze Ⅳ radiofrequency ablation while valve replacement. The ratio of male to female was 32:24, aged 41-68, and course of atrial fibrillation was 3-28 years. Amiodarone was taken continuously 3 months after operation and ECG was reexamined before discharge and every 3 months after operation. Results:The sinus rhythm ratio was 87.5% (49 cases) when discharged from hospital. The follow-up time was 6-48 months. At the last follow-up, 45 patients(80.3%) with sinus rhythm maintained a sinus rhythm. Conclusions:Valve replacement and modified left atrial box 5 zone maze Ⅳradiofrequency ablation can be performed simultaneously in patients with valvular disease complicated with atrial fibrillation. The operation is safe and effective. The adjuvant application of amiodarone after operation can achieve satisfactory sinus rhythm maintenance rate.

参考文献:

[1] GILLINOV A M,SALTMAN A E.Ablation of atrial fibrillation with concomitant cardiac surgery[J].Semin Thorac Cardiovasc Surg,2007,19(1):25-32.
[2] AD N,SURI R M,GAMMIE J S,et al.Surgical ablation of atrial fibrillation trends and outcomes in North America[J].J Thorac Cardiovasc Surg,2012,144:1051-1060.
[3] BAGSHAW S M,GALBRAITH P D,MITCHELL L B,et al.Prophylactic amiodarone for prevention of atrial fibrillation after cardioc surgery:a meta-analysis[J].Ann Thorac Surg,2006,82(5):1927-1937.
[4] AD N,HENRY L,MASSIMIANO P,et al.The state of surgical ablation for atrial fibrillation in patients with mitral valve disease[J].Curr Opin Cardiol,2013,28(2):170-180.
[5] JANUARY C T,WANN L S,ALPERT J S,et al.2014 AHA/ACC/HRS guideline 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 Heart Rhythm Society[J].Circulation,2014,130:2071-2104.
[6] WOLF P A,MITCHELL J B,BAKER C S,et al.Impact of atrial fibrillation on mortality,stroke,and medical cost[J].Arch Intern Med,1998,158(3):229-234.
[7] MOUKABARY T,GONZALEZ M D.Management of atrial fibrillation[J].Med Clin North Am,2015,99(4):781-794.
[8] VIVEK S,SUSHEEL K,SATISH J,et al.Efficacy of three different ablative procedures to treat atrial fibrillation in patients with valvular heart disease:a randomized trial[J].Heart Lung Circ,2008,17(3):232-240.
[9] PRASAD S M,MANIAR H S,DIODATO M D,et al.Physiological consequences of bipolar radiofrequency energy on the atrial and pulmonary veins:a chronic animal study[J].Ann Thorac surg,2003,76(3):836-842.
[10] PRASAD S M,MANIAR H S,SCHUESSLER R B,et al.Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart[J].J Thorac Cardiovasc Surg,2002,124(4):708-713.
[11] ADELBORG K,EBBEHØJ E,NIELSEN J C,et al.Treatment with amiodarone[J].Ugeskr Laeger,2015,177(24):1168-1171.
[12] AD N,HOLMES S D,MASSIMIANO P S,et al.The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery[J].J Thorac Cardiovasc Surg,2013,146(6):1426-1434.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 169522 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364