薛玉梅,詹贤章,郭惠明,刘洋,邓海,方咸宏,廖洪涛,魏薇,李腾,吴书林

• 1:广东省心血管病研究所 广东省人民医院心内科 广东省医学科学院

摘要(Abstract)：

目的评价风湿性心脏病瓣膜置换术后心房颤动(房颤)消融的效果和安全性。方法入选2008年至2013年在广东省人民医院心内科接受房颤导管消融治疗的风湿性心脏病瓣膜置换术患者,分析其临床特征、消融策略及消融成功率。结果共纳入23例患者,男8例,女15例,平均年龄(51.0±9.2)岁。单纯二尖瓣置换术患者13例(56.5%),二尖瓣、主动脉瓣双瓣置换术10例(43.5%),其中5例同时进行三尖瓣置换或整形术。外科术后阵发性房颤患者14例(60.9%),非阵发性房颤9例(39.1%);这些患者在外科术前心律情况为9例窦性心律,4例阵发性房颤,10例非阵发性房颤。导管消融距离外科手术时间为(6.9±5.8)年,外科术后发生房颤病程(3.1±3.2)年,左、右心房内径分别为(44.1±5.9)mm、(48.1±9.0)mm,左心室射血分数64.0%±8.3%。平均消融手术时间(156.8±46.6)min,X线曝光时间(27.3±11.2)min。随访(29.7±21.2)个月,其中4例(17.4%)患者接受再次消融术;14例(60.9%)维持窦性心律(6例服用胺碘酮),1例死亡,2例失访,6例复发(包括2例持续性房颤,1例阵发性房颤,2例偶发性心房扑动,1例阵发性房性心动过速)。结论风湿性心脏病瓣膜置换术后房颤导管消融有效、安全,步进式导管消融策略可能较为合适。

关键词(KeyWords)： 风湿性心脏病;外科;心房颤动;导管消融

Abstract:

Keywords:

基金项目(Foundation): 广东省科技计划项目(2012B031800316,2012B061800047,2010B031500018)

作者(Author): 薛玉梅,詹贤章,郭惠明,刘洋,邓海,方咸宏,廖洪涛,魏薇,李腾,吴书林

参考文献(References)：

• [1]黄从新,张澍,马长生,等.心房颤动:目前的认识和治疗建议2012.中华心律失常学杂志,2012,16:246-289.
• [2]Grigioni F,Avierinos JF,Ling LH,et al.Atrial fibrillation complicating the course of degenerative mitral regurgitation:determinants and long-term outcome.J Am Coll Cardiol,2002,40:84-92.
• [3]葛均波.评国内首例经导管二尖瓣修复术成功.中国介入心脏病学杂志,2012,20:121-122.
• [4]Lim KT,Matsuo S,O'Neill MD,et al.Catheter ablation of persistent and permanent atrial fi brillation:Bordeaux experience.Expert Rev Cardiovasc Ther,2007,5:655-662.
• [5]Mountantonakis S,Frankel DS,Hutchinson MD,et al.Feasibility of catheter ablation of mitral annular flutter in patients with prior mitral valve surgery.Heart Rhythm,2011,8:809-814.
• [6]Lakkireddy D,Nagarajan D,Di Biase L,et al.Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves:a feasibility,safety,and effi cacy study.Heart Rhythm,2011,8:975-980.
• [7]Hussein AA,Wazni OM,Harb S,et al.Radiofrequency ablation of atrial fi brillation in patients with mechanical mitral valve prostheses safety,feasibility,electrophysiologic fi ndings,and outcomes.J Am Coll Cardiol,2011,58:596-602.
• [8]Liu X,Tan HW,Wang XH,et al.Effi cacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease:a randomized trial.Eur Heart J,2010,31:2633-2641.
• [9]Cox JL,Schuessler RB,Boineau JP.The development of the Maze procedure for the treatment of atrial fibrillation.Semin Thorac Cardiovasc Surg,2000,12:2-14.
• [10]Gillinov AM.Ablation of atrial fi brillation with mitral valve surgery.Curr Opin Cardiol,2005,20:107-114.
• [11]Ishii Y,Gleva MJ,Gamache MC,et al.Atrial tachyarrhythmias after the maze procedure:incidence and prognosis.Circulation,2004,110:Ⅱ164-Ⅱ168.
• [12]Ishii Y,Nitta T.Atrial fibrillation surgery for patients with rheumatic valve disease.J Interv Card Electrophysiol,2007,20:109-112.
• [13]Wu M,Zhang S,Dong A,et al.Long-term outcomes of maze procedure plus valve replacement in treating rheumaticvalve disease resulting in atrial fibrillation.Ann Thorac Surg,2010,89:1942-1949.