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目的:评估胸腔镜外科射频消融联合介入导管消融治疗长程持续性心房颤动(房颤)的安全性、可行性,总结初步的治疗经验。方法:2014-04至2016-03,连续在我院接受胸腔镜外科射频消融联合介入导管消融治疗长程持续性房颤患者15例,男性13例,平均房颤持续时间(4.0±3.9)年。所有患者先在胸腔镜下应用双极射频消融钳行肺静脉隔离、左心房后壁隔离、Waterston’s沟神经节消融、左心耳切除和Marshall韧带离断;然后左心房三维建模,结合左心房电压标测,应用导管消融对胸腔镜外科消融线进行强化或修饰消融,确保双向阻滞,同时消融左心房嵴部、二尖瓣峡部,部分患者消融左心房前壁和三尖瓣峡部。术后3个月、6个月、12个月进行定期随访。结果:13例患者术毕即转复为窦性心律,无手术并发症。15例患者平均随访(12.1±11.5)个月。2例转复窦性心律患者在术后3个月因心房扑动再次介入导管消融恢复窦性心律。总体治疗成功率86.7%(13/15),均未再服用抗心律失常药物。结论:胸腔镜外科射频消融联合介入导管消融治疗长程持续性房颤是一种创伤小、安全而有效的方法。
Objective: To evaluate the safety and feasibility of thoracoscopic radiofrequency ablation combined with interventional catheter ablation in the treatment of long-term persistent atrial fibrillation (AF) and to summarize the initial treatment experience. Methods: From April 2014 to March 2016, 15 consecutive patients undergoing thoracoscopic radiofrequency catheter ablation combined with interventional catheter ablation were treated in our hospital. Among them, 13 were males and the average duration of atrial fibrillation was 4.0 ± 3.9 years. All patients underwent primary thoracoscopic radiofrequency ablation with pulmonary venous isolation, left atrial posterior wall isolation, Waterston’s ditch ganglion ablation, left atrial appendage resection and Marshall ligament rupture. Then left atrial three-dimensional modeling, combined with left atrial voltage scale Measurement and application of catheter ablation of the thoracoscopic surgical ablation line to strengthen or ablation to ensure bidirectional block, ablation of the left atrial ridge, mitral isthmus, some patients with ablation of the left anterior wall and tricuspid isthmus. After 3 months, 6 months, 12 months for regular follow-up. Results: Thirteen patients converted to sinus rhythm at the end of surgery, no complications were found. Fifteen patients were followed up for an average of (12.1 ± 11.5) months. Two patients with sinus rhythm revascularization after reinstatement of atrial flutter 3 months after surgery to restore sinus rhythm. The overall success rate of treatment was 86.7% (13/15), no anti-arrhythmic drugs were taken any more. Conclusions: Video-assisted thoracoscopic radiofrequency ablation combined with interventional catheter ablation is a safe, effective and safe method for the treatment of long-term persistent atrial fibrillation.