房间隔缺损合并心房颤动的外科治疗方法及效果研究
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摘要
目的:探讨房间隔缺损(ASD)合并心房颤动的外科治疗方法。方法:自2013年1月至2018年6月,对112例ASD合并心房颤动患者行ASD修补+心房颤动射频消融手术(标准迷宫Ⅳ)治疗,观察其效果。结果:所有患者成功完成手术,主动脉阻断和体外循环时间分别为(65±12)vs.(90±11)min,心房颤动射频消融时间为(18±6.5)min,开放循环后窦性心律85例(75.9%),结性心律16例(14.3%),心房颤动心律11例(9.8%),平均术后住院时间(8±2.1)d,术后随访105例,随访3～60个月,平均(28±6)个月,窦性心律65例(61.9%),结性心律11例(10.4%),心房颤动心律29例(27.6%),本组无死亡。结论:ASD修补术同期心房颤动迷宫Ⅳ手术安全可行,疗效确切,不增加手术及体外循环时间。
Objective: to explore the surgical treatment of atrial septal defect combined with atrial fibrillation. Methods: 112 patients with atrial septal defect and atrial fibrillation were treated in our hospital from January 2013 to June 2018. Atrial septal defect were repaired with concomitant radiofrequency ablation(standard maze Ⅳ) for atrial fibrillation, The therapeutic effect was observed. Results: All surgeries were successfully completed, aorta cross-clamp and extracorporeal time were(65 ±12) min and(90±11) min respectively, and atrial fibrillation radiofrequency time was(18±6.5)min, 85 cases were sinus rhythm after cardioversion(75.9%), 16 cases(14.3%) were nodal rhythm, and 11 cases(9.8%) were atrial fibrillation rhythm. The mean length of hospital stay was(8±2.1) days, postoperative follow-up of 105 cases were followed up for(28±6.65) months, sinus rhythm 65 cases(61.9%), nodal rhythm 11 cases(10.4%), There were 29 cases(27.6%) of atrial fibrillation heart rhythm, there was no death. Conclusions: Repair of atrial septal defects with concomitant maze Ⅳ surgical ablation for atrial fibrillation is a safer and reliable procedure without increasing extracorporeal and operative time.
Objective: to explore the surgical treatment of atrial septal defect combined with atrial fibrillation. Methods: 112 patients with atrial septal defect and atrial fibrillation were treated in our hospital from January 2013 to June 2018. Atrial septal defect were repaired with concomitant radiofrequency ablation(standard maze Ⅳ) for atrial fibrillation, The therapeutic effect was observed. Results: All surgeries were successfully completed, aorta cross-clamp and extracorporeal time were(65 ±12) min and(90±11) min respectively, and atrial fibrillation radiofrequency time was(18±6.5)min, 85 cases were sinus rhythm after cardioversion(75.9%), 16 cases(14.3%) were nodal rhythm, and 11 cases(9.8%) were atrial fibrillation rhythm. The mean length of hospital stay was(8±2.1) days, postoperative follow-up of 105 cases were followed up for(28±6.65) months, sinus rhythm 65 cases(61.9%), nodal rhythm 11 cases(10.4%), There were 29 cases(27.6%) of atrial fibrillation heart rhythm, there was no death. Conclusions: Repair of atrial septal defects with concomitant maze Ⅳ surgical ablation for atrial fibrillation is a safer and reliable procedure without increasing extracorporeal and operative time.
引文
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[3] Chaowu Y, Hua L, Xin S. Three-dimensional printing as an aid in transcatheter closure of secundum atrial septal defect with rim deficiency: in vitro trial occlusion based on a personalized heart model[J]. Circulation, 2016, 133(17): e608-e610.
[4] Morillo C A, Verma A, Connolly S J, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial[J]. JAMA, 2014, 311(7): 692-700.
[5] Kuck K H, Fürnkranz A, Chun K R J, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial[J]. Eur Heart J, 2016, 37(38): 2858-2865.
[6] Marrouche N F, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study [J]. JAMA, 2014, 311(5): 498-506.
[7] Henn M C, Lancaster T S, Miller J R, et al. Late outcomes after the Cox maze IV procedure for atrial fibrillation [J]. J Thoracic Cardiovasc Surg, 2015, 150(5): 1168-1178. e2.
[8] Macle L, Cairns J, Leblanc K, et al. 2016 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation [J]. Canadian J Cardiol, 2016, 32(10): 1170-1185.
[9] Alb?ge A, Johansson B, Kenneb?ck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze III procedure for atrial fibrillation[J]. Ann Thoracic Surg, 2016, 101(4): 1443-1449.
[10] Musharbash F N, Schill M R, Sinn L A, et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery[J]. J Thoracic Cardiovasc Surg, 2018, 155(1): 159-170.
[11] Lawrance C P, Henn M C, Miller J R, et al. Comparison of the stand-alone Cox-Maze IV procedure to the concomitant Cox-Maze IV and mitral valve procedure for atrial fibrillation[J]. Ann Cardiothoracic Surg, 2014, 3(1): 55.
[12] Han J, Wang H, Wang Z, et al. Safety and efficacy of Cox-maze Ⅲ procedure for atrial fibrillation associated with degenerative mitral regurgitation: a propensity-matched comparison to patients without atrial fibrillation[J]. Chinese J Thoracic Cardiovasc Surg, 2017, 33(8): 466-471.
[13] Tsai F C, Ho H T, Chang J P, et al. The prognostic scoring system establishment and validation for chronic atrial fibrillation patients receiving modified cox-maze IV and concomitant cardiac surgery[J]. PloS one, 2015, 10(6): e0126300.
[14] 刘健, 黄击修, 林小彬, 等. 不中断冠状动脉循环下直视双极射频消融治疗心房颤动[J]. 中国胸心血管外科临床杂志, 2017,17(5): 425-427.
[15] Jones C, Pollit V, Fitzmaurice D, et al. The management of atrial fibrillation: summary of updated NICE guidance[ J]. BMJ, 2014, 348: g3655.
[16] 孔强,史力生,喻荣辉,等. 右心房扩大对心房颤动射频消融治疗影响的研究[J].心肺血管病杂志, 2017,36 (12): 999-1003.
[17] Flaker G, Lopes R D, Al-Khatib S M, et al. Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation)[J]. J Am Coll Cardiol, 2014, 63(11): 1082-1087.
[2] Rodés-Cabau J, Horlick E, Ibrahim R, et al. Effect of clopidogrel and aspirin vs aspirin alone on migraine headaches after transcatheter atrial septal defect closure: the CANOA randomized clinical trial[J]. JAMA, 2015, 314(20): 2147-2154.
[3] Chaowu Y, Hua L, Xin S. Three-dimensional printing as an aid in transcatheter closure of secundum atrial septal defect with rim deficiency: in vitro trial occlusion based on a personalized heart model[J]. Circulation, 2016, 133(17): e608-e610.
[4] Morillo C A, Verma A, Connolly S J, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial[J]. JAMA, 2014, 311(7): 692-700.
[5] Kuck K H, Fürnkranz A, Chun K R J, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial[J]. Eur Heart J, 2016, 37(38): 2858-2865.
[6] Marrouche N F, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study [J]. JAMA, 2014, 311(5): 498-506.
[7] Henn M C, Lancaster T S, Miller J R, et al. Late outcomes after the Cox maze IV procedure for atrial fibrillation [J]. J Thoracic Cardiovasc Surg, 2015, 150(5): 1168-1178. e2.
[8] Macle L, Cairns J, Leblanc K, et al. 2016 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation [J]. Canadian J Cardiol, 2016, 32(10): 1170-1185.
[9] Alb?ge A, Johansson B, Kenneb?ck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze III procedure for atrial fibrillation[J]. Ann Thoracic Surg, 2016, 101(4): 1443-1449.
[10] Musharbash F N, Schill M R, Sinn L A, et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery[J]. J Thoracic Cardiovasc Surg, 2018, 155(1): 159-170.
[11] Lawrance C P, Henn M C, Miller J R, et al. Comparison of the stand-alone Cox-Maze IV procedure to the concomitant Cox-Maze IV and mitral valve procedure for atrial fibrillation[J]. Ann Cardiothoracic Surg, 2014, 3(1): 55.
[12] Han J, Wang H, Wang Z, et al. Safety and efficacy of Cox-maze Ⅲ procedure for atrial fibrillation associated with degenerative mitral regurgitation: a propensity-matched comparison to patients without atrial fibrillation[J]. Chinese J Thoracic Cardiovasc Surg, 2017, 33(8): 466-471.
[13] Tsai F C, Ho H T, Chang J P, et al. The prognostic scoring system establishment and validation for chronic atrial fibrillation patients receiving modified cox-maze IV and concomitant cardiac surgery[J]. PloS one, 2015, 10(6): e0126300.
[14] 刘健, 黄击修, 林小彬, 等. 不中断冠状动脉循环下直视双极射频消融治疗心房颤动[J]. 中国胸心血管外科临床杂志, 2017,17(5): 425-427.
[15] Jones C, Pollit V, Fitzmaurice D, et al. The management of atrial fibrillation: summary of updated NICE guidance[ J]. BMJ, 2014, 348: g3655.
[16] 孔强,史力生,喻荣辉,等. 右心房扩大对心房颤动射频消融治疗影响的研究[J].心肺血管病杂志, 2017,36 (12): 999-1003.
[17] Flaker G, Lopes R D, Al-Khatib S M, et al. Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation)[J]. J Am Coll Cardiol, 2014, 63(11): 1082-1087.