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目的探讨心脏直视下射频消融肺静脉口治疗风湿性心脏病心房颤动(房颤)的临床疗效。方法对20例风湿性心瓣膜病伴房颤患者(治疗组),在瓣膜置换术中应用射频探针在左心房内行直视下围绕4个肺静脉口的环形线性消融及消融环最低点与二尖瓣环连线的直线消融,输出功率30～40 W,每次放电时间45～60 s。以20例单纯行瓣膜置换术的风湿性心瓣膜病伴房颤患者为对照组,两组均同时应用胺碘酮辅助治疗,比较两组治疗房颤的疗效。患者治疗后均获得随访,平均随访(24±3)个月。结果治疗组心脏复跳后19例转为窦性心律,住院期间房颤复发2例,随访中房颤复发1例,总有效率80%(16／20)；对照组心脏复跳后16例为窦性心律,住院期间房颤复发7例,随访中房颤复发2例,总有效率35%(7/20)无心房穿孔、出血及房室传导阻滞等并发症。结论直视下射频消融肺静脉口治疗风湿性心脏病房颤有效率较高,方法简单,并发症少。
Objective To investigate the clinical effect of radiofrequency ablation of pulmonary vein ostium under rheumatic heart disease in the treatment of rheumatic heart disease with atrial fibrillation (AF). Methods Twenty patients with rheumatic valvular disease accompanied with atrial fibrillation (treatment group) underwent ring-shaped linear ablation and the lowest point of ablation ring with radiofrequency probe in the left atrium under direct vision. Mitral annulus ring straight line ablation, the output power of 30 ~ 40 W, each discharge time 45 ~ 60 s. Twenty patients with rheumatic valvular heart disease and atrial fibrillation who underwent simple valvuloplasty were selected as the control group. Amiodarone adjuvant therapy was used in both groups. The therapeutic effects of atrial fibrillation in both groups were compared. Patients were followed up after treatment, the average follow-up (24 ± 3) months. Results In the treatment group, 19 cases were converted to sinus rhythm after cardiopulmonary resuscitation, 2 cases were atrial fibrillation during hospitalization, 1 case was atrial fibrillation at follow-up, the total effective rate was 80% (16/20); in the control group, 16 cases In sinus rhythm, 7 cases of atrial fibrillation recurrence during hospitalization, 2 cases of atrial fibrillation recurrence at follow-up, the total efficiency of 35% (7/20) without atrial perforation, bleeding and atrioventricular block and other complications. Conclusions Under direct vision radiofrequency ablation of pulmonary vein ostium is effective in treating atrial fibrillation of rheumatic heart disease. The method is simple and has fewer complications.