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目的探索非体外循环下心外膜微波消融术治疗心房颤动(房颤)的临床应用效果。方法从2003年4月至2005年4月对46例持续性房颤患者进行了非体外循环下心外膜消融术,其中二尖瓣病变28例、二尖瓣合并主动脉病变5例,冠心病8例、孤立性房颤5例。将FLEX10微波探头完整包绕4个肺静脉入口及下腔静脉开口至三尖瓣环,微波能量65W、90s进行连续性心外膜消融,然后在体外循环下行瓣膜置换术或不停跳冠状动脉旁路术。术前平均左房直径(52.5±15.3)mm,左室射血分数42%~70%。所有病例均于出院时和术后3、6、12个月行标准12导联心电图、24hHolter、超声心动图及临床检查进行随访。结果本组病例均成功进行了心外膜微波消融术并于术中消除房颤,无手术死亡及手术相关的并发症。微波消融时间平均(37.7±7.8)min,成功率为63.0%;随访窦性心律维持率:出院时为63.0%,3个月为66.7%,6个月为72.7%,12个月为80.6%,且左房内径<50mm。结论非体外循环下心外膜微波消融术可以达到肺静脉电学隔离治疗房颤的目的,在合并或不合并心脏器质性病变的持续性房颤外科治疗中有较低的风险和良好效果。
Objective To explore the clinical effect of epicardial microwave ablation on off-pump atrial fibrillation (AF). Methods From April 2003 to April 2005, 46 patients with persistent AF underwent off-pump epicardial ablation. Among them, 28 were mitral valve disease, 5 were mitral valve disease with aortic disease, 5 were coronary heart disease 8 cases, 5 cases of isolated atrial fibrillation. The FLEX10 microwave probe was completely wrapped around the four pulmonary vein entrance and the inferior vena cava opening to the tricuspid annulus, microwave energy 65W, 90s for continuous epicardial ablation, and then under cardiopulmonary bypass valve replacement or non-stop coronary artery bypass Road surgery. The average preoperative left atrium diameter (52.5 ± 15.3) mm, left ventricular ejection fraction 42% to 70%. All cases were followed up for standard 12-lead electrocardiogram, 24hHolter, echocardiography and clinical examination at discharge, 3,6,12 months after operation. Results All the patients underwent successful epicardial microwave ablation and eliminated atrial fibrillation during operation. There was no operative death and operation-related complications. The average time of microwave ablation was (37.7 ± 7.8) min, with a success rate of 63.0%. Follow-up of sinus rhythm maintenance rate was 63.0% at discharge, 66.7% at 3 months, 72.7% at 6 months and 80.6% at 12 months , And left atrial diameter <50mm. CONCLUSIONS: Extracorporeal microwave ablation can achieve the goal of atrial fibrillation after pulmonary vein electrical isolation without cardiopulmonary bypass, and it has a lower risk and good effect in the surgical treatment of persistent atrial fibrillation with or without organic heart disease.