2021 年第 9 期 第 16 卷

心脏外科手术同期射频消融治疗心房颤动的有效性和安全性

Effect and safety of radiofrequency ablation for atrial fibrillation during cardiac surgeries

作者：魏涛1李学文1王宗超1黄晓燕2石践1宋宝国1张国安1王沙1刘强1王志坤1王侃1冯大伟1马美娟3张曦1

英文作者：Wei Tao1 Li Xuewen1 Wang Zongchao1 Huang Xiaoyan2 Shi Jian1 Song Baoguo1 Zhang Guoan1 Wang Sha1 Liu Qiang1 Wang Zhikun1 Wang Kan1 Feng Dawei1 Ma Meijuan3 Zhang Xi1

单位：1陕西省人民医院心脏外科，西安710068；2陕西省人民医院陕西省感染与免疫疾病重点实验室，西安710068；3陕西省人民医院心血管内一科，西安710068

英文单位：1Department of Cardiac Surgery Shaanxi Provincial People′s Hospital Xi′an 710068 China; 2Key Laboratory of Infection and Immune Diseases in Shaanxi Province Shaanxi Provincial People′s Hospital Xi′an 710068 China; 3the First Department of Cardiovascular Medicine Shaanxi Provincial People′s Hospital Xi′an 710068 China

关键词：心脏手术；心房颤动；射频消融；左心房内径；抗凝

英文关键词：Cardiacsurgery；Atrialfibrillation；Radiofrequencyablation；Leftatrialdiameter；Anticoagulation

• 摘要：

• 目的 观察心脏瓣膜病和先天性心脏病外科手术同期射频消融治疗心房颤动的有效性和安全性。方法 选取2018年11月至2020年1月陕西省人民医院收治的行外科手术的心脏瓣膜病及先天性心脏病患者119例，患者术前均合并心房颤动，在外科手术同期行射频消融治疗。术后随访6个月。出院时及随访6个月时复查心电图，按照是否恢复窦性心律分为窦性心律组和心房颤动或心房扑动组。比较2组出院时及随访6个月时心脏超声指标。结果 术后7～19 d出院时恢复窦性心律96例（80.7%），心房颤动21例（17.6%），心房扑动（术后9 d）2例（1.7%）。随访6个月时死亡1例，维持窦性心律者93例（78.2%）。出院时及随访6个月时，窦性心律组左心房内径均明显小于术前［（44.6±5.2）mm比（49.7±6.8）mm、（42.1±5.3）mm比（48.7±4.1）mm］（均P＜0.05），心房颤动或心房扑动组左心房内径与术前比较，差异均无统计学意义（均P＞0.05）。结论 心脏外科手术同期射频消融治疗心房颤动手术安全、效果满意。出院及随访6个月时转复窦性心律者左心房内径缩小。

• Objective To observe the effect and safety of radiofrequency ablation for atrial fibrillation during surgeries for valvular diseases and congenital heart diseases. Methods From November 2018 to January 2020, 119 patients with valvular disease and congenital heart disease undergoing surgery in Shaanxi Provincial People′s Hospital were enrolled. All patients were complicated with atrial fibrillation before surgery and were treated with radiofrequency ablation during cardiac surgeries. After surgery, they were followed-up for 6 months. Electrocardiogram was reviewed at discharge and 6 months of follow-up, and patients were divided into sinus rhythm group and atrial fibrillation/flutter group according to sinus rhythm recovery. Cardiac ultrasound indexes at discharge and 6 months of follow-up were compared between the two groups. Results At discharge, 7-19 d after surgery, 96 cases （80.7%）regained sinus rhythm, 21 cases(17.6%) were atrial fibrillation, and 2 cases (1.7%) were atrial flutter(9 d after surgery). At 6 months of follow-up, 1 case died and 93 cases (78.2%) remained sinus rhythm. Compared with preoperation, the left atrial diameter in sinus rhythm group decreased at discharge and 6 months of follow-up ［(44.6±5.2)mm vs (49.7±6.8)mm, (42.1±5.3)mm vs (48.7±4.1)mm］(both P＜0.05), and there were no significant differences in left atria diameter in atrial fibrillation/flutter group compared with that before surgery(both P＞0.05). Conclusions Concomitant radiofrequency ablation for AF with cardiac surgery is safe and effective. Patients regained sinus rhythm have a decrease in left atrial diameter at discharge and 6 months of follow-up.