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目的:对合并心房颤动(房颤)的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,评价冲洗射频改良迷宫Ⅲ手术在心内直视手术中治疗房颤的临床效果。方法:从2004-05开始,采用Medtronic公司的射频消融系统对115例合并房颤的心脏病患者行心内直视手术的同时进行冲洗射频改良迷宫Ⅲ手术,其中包括双瓣置换术48例、二尖瓣置换术49例、主动脉瓣置换术2例、冠状动脉搭桥术同时行瓣膜置换术11例、冠状动脉搭桥术1例、三尖瓣置换术1例、其他手术3例。术后应用胺碘酮6个月。结果:115例患者手术当日109例房颤消除,其中95例为窦性心律,14例为结性心律;6例仍为房颤心律,房颤消除率为94.8%。术后随访3个月,82例维持窦性心律,10例为房性心律,房颤消除率为80%;14例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;9例仍为房颤心律。随访12～24个月,全组115例患者中80例维持窦性心律,11例为房性心律,房颤消除率为79.1%;9例基础心律为窦性心律或结性心律,但仍偶有房颤、房扑间断发作;15例为房颤。结论:冲洗射频消融改良迷宫手术在治疗合并有房颤的心脏疾病的心内直视手术中安全、简便、易于操作,而且疗效确切,值得推广应用。术中心内膜消融与心外膜消融相结合、左房显著扩大者增添左右肺静脉之间消融线;术后避免中心静脉压过高、维持正常范围内稍高的血钾浓度有利于提高房颤转复成功率和维持稳定的窦性心律。
Objective: To evaluate the clinical effect of rinsed radio frequency modified maze Ⅲ surgery in the treatment of atrial fibrillation under open heart surgery. METHODS: From 2004-05, a total of 115 cases of heart disease with atrial fibrillation undergoing open-heart surgery were treated with radiofrequency modified maze Ⅲ surgery including 48 cases of double-flap replacement with Medtronic radiofrequency ablation system. Mitral valve replacement in 49 cases, aortic valve replacement in 2 cases, coronary artery bypass surgery simultaneously valve replacement in 11 cases, coronary artery bypass surgery in 1 case, tricuspid valve replacement in 1 case, other surgery in 3 cases. Amiodarone 6 months after surgery. Results: A total of 109 cases of atrial fibrillation were eliminated on the day of surgery, 95 cases were sinus rhythm and 14 cases were nodal rhythm. Six cases were still atrial fibrillation with atrial fibrillation rate of 94.8%. After 3 months of follow-up, 82 patients maintained sinus rhythm, 10 patients had atrial rhythm, and the rate of atrial fibrillation was 80%. In 14 patients, the basic rhythm was sinus rhythm or rhythm, Flutter intermittent attack; 9 cases were still atrial fibrillation. During the follow-up period of 12-24 months, 80 of 115 patients in the whole group maintained sinus rhythm, 11 were atrial rhythm, and the rate of atrial fibrillation was 79.1%. Nine patients had sinus rhythm or nodal rhythm Occasional atrial fibrillation, intermittent atrial flutter episodes; 15 cases of atrial fibrillation. Conclusion: Radiofrequency ablation improved maze surgery in the treatment of heart disease complicated with atrial fibrillation in open heart surgery is safe, simple and easy to operate, and the curative effect is exact, it is worth popularizing and applying. Intraoperative endocardial ablation and epicardial ablation combined with left atrial enlargement significantly increased the left and right pulmonary vein ablation line; postoperative avoid central venous pressure is too high to maintain the normal range of slightly higher potassium concentration is conducive to improving atrial fibrillation Success rate of conversion and maintenance of stable sinus rhythm.