• 1.首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院 心外科ICU;;
  • 2.心外科,北京 100029;

目的 隨訪心房顫動患者行外科射頻消融治療術(shù)后5年的心律,分析術(shù)前左心房內(nèi)徑(LAD)對射頻消融術(shù)治療心房顫動療效的確切影響?!》椒ā』仡櫺苑治?006~2009年北京安貞醫(yī)院行心臟直視手術(shù)同期行雙極射頻消融術(shù)的持續(xù)性和永久性心房顫動患者433例的臨床資料。根據(jù)術(shù)前LAD的大小將患者分為4組:A組,LAD< 50 mm,75例,男22例、女53例,年齡(56.50±10.05)歲;B組,LAD 50~60 mm,89例,男32例、女57例,年齡(55.63±10.28)歲;C組,LAD 60~70 mm,117例,男41例、女76例,年齡(55.13±10.96)歲;D組,LAD>70 mm,152例,男68例、女84例,年齡(53.22±11.49)歲。收集各組術(shù)后即刻、出院時心電圖,隨訪術(shù)后第6個月、1年、2年、3年、4年和5年心電圖中心律類型,分析患者術(shù)前LAD與行射頻消融術(shù)后竇性心律轉(zhuǎn)復(fù)率的關(guān)系?!〗Y(jié)果 4組患者術(shù)后即刻(P=0.011)、出院(P=0.002)、術(shù)后6個月(P<0.001)、1年(P<0.001)、2年(P<0.001)、3年(P<0.001)、 4年(P<0.001) 和5年(P=0.006) 竇性心律轉(zhuǎn)復(fù)率差異均有統(tǒng)計學(xué)意義。術(shù)后6個月、1年、2年、3年、4年和5年A組患者的竇性心律轉(zhuǎn)復(fù)率分別為90.4%、89.9%、90.3%、91.3%、89.1%和90.9%,B組分別為80.2%、79.0%、78.1%、76.1%、72.5%和70.0%,C組分別為74.7%、74.0%、71.2%、72.4%、70.0%和64.7%,D組分別為61.8%、57.6%、56.8%、53.9%、50.7%和48.6%?!〗Y(jié)論 術(shù)前LAD越大,術(shù)后竇性心律維持率越低。

引用本文: 李菲,孟旭. 術(shù)前左心房內(nèi)徑對外科射頻消融術(shù) 治療心房顫動療效的影響. 中國胸心血管外科臨床雜志, 2013, 20(1): 38-42. doi: 復(fù)制

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4.  Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified  Cox-maze procedure for elderly patients:a risk analysis for failure. Interact Cardiovasc Thorac Surg, 2011, 12 (6):924-928.
5.  Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cartiothorac Surg, 2009, 36 (2):267-271.
6.  Wang J, Meng X, Li H, et al. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2009, 35 (1):116-122.
7.  Joao M, PedroAdrag, Jose N. Surgery for atrial fibrillation using radiofrequency catheter ablation:assessment of results at one year. Euro J Cardio-thorac Surg, 1999, 15 (6):851-855.
8.  Williams MR, Stewart JR, Bolling SF, et al. Surgical treatment of atrial fibrillation using radiofrequency energy. Ann Thorac Surg, 2001, 71 (6):1939-1944.
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10.  Stulak JM, Sundt TM 3rd, Dearani JA, et al. Ten-year experience with the Cox-maze procedure for atrial fibrillation:how do we define success? Ann Thorac Surg, 2007, 83 (4):1319-1324.
11.  Anné W, Willems R, Roskams T, et al. Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation. Cardiovasc Res, 2005, 67 (4):655-666.
12.  Casaclang-Verzosa CF, Bernard JA. Structural and functional  remodeling of the left atrium:clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol, 2008, 51 (1):1-11.
13.  Kainuma S, Masai T, Yoshitatsu M, et al. Advanced left-atrial fibrosis is associated with unsuccessful maze operation for valvular atrial fibrillation. Eur J Cardiothorac Surg, 2011, 40 (1):61-69.
14.  Schoonderwoerd BA, Van Gelder IC, Van Veldhuisen DJ, et al. Electrical and structural remodeling:role in the genesis and maintenance of atrial fibrillation. Prog Cardiovasc Dis, 2005, 48 (3):153-168.
15.  Vest JA, Wehrens XH, Reiken SR, et al. Defective cardiac ryanodine  receptor regulation during atrial fibrillation. Circulation, 2005, 111 (16):2025-2032.
16.  Li D, Melnyk P, Feng J, et al. Effects of experimental heart failure on atrial cellular and Ionic electrophysiology. Circulation, 2000, 101 (22):2631-2638.
17.  Kout SE, Lam RS, Seebohm G, et al. Modulation of human Kv1. 5 channel kinetics by N-cadherin.Biochem Biophys Res Commun, 2007, 363 (1):18-23.
18.  Everett TH 4th, Li H, Mangrum JM, et al. Electrical, morphological, and ultrastructural remodeling and reverse remodeling in a canine model of chronic atrial fibrillation. Circulation, 2000, 102 (12):1454-1460.
19.  Everett TH, Wilson EE, Verheule S, et al. Structural atrial remodeling  alters the substrate and spatiotemporal organization of atrial fibrillation:  a comparison in canine models of structural and electrical atrial remod-  eling. Am J Physiol Heart Circ, 2006, 291 (6):H2911-H2923.
20.  Nademanee K, Schwab MC, Kosar EM, et al. Clinical outcomes of catheter substrate ablation for high-risk patients with atrial fibrillation. J Am Coll Cardiol, 2008, 51 (8):843-849.
21.  Benussi S, Nascimbene S, Calori G, et al. Surgical ablation of atrial fibrillation with a novel bipolar radiofrequency device. Thorac  Cardiovasc Surg, 2005, 130 (2):491-497.
  1. 1.  汪曾煒, 劉維永, 張寶仁, 主編. 心臟外科學(xué). 北京:人民軍醫(yī)出版社, 2003. 1691-1710..
  2. 2.  Gillinov AM, Bhavani S, Blackstone EH, et al. Surgery for permanent atrial fibrillation:impact of patient factors and lesion set. Ann Thorac Surg, 2006, 82 (2):502-514.
  3. 3.  Kobayashi T, Komiya T, Tamura N, et al. Long-term result of the maze procedure for atrial fibrillation. Kyobu Geka, 2010, 63 (4):271-275.
  4. 4.  Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified  Cox-maze procedure for elderly patients:a risk analysis for failure. Interact Cardiovasc Thorac Surg, 2011, 12 (6):924-928.
  5. 5.  Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cartiothorac Surg, 2009, 36 (2):267-271.
  6. 6.  Wang J, Meng X, Li H, et al. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2009, 35 (1):116-122.
  7. 7.  Joao M, PedroAdrag, Jose N. Surgery for atrial fibrillation using radiofrequency catheter ablation:assessment of results at one year. Euro J Cardio-thorac Surg, 1999, 15 (6):851-855.
  8. 8.  Williams MR, Stewart JR, Bolling SF, et al. Surgical treatment of atrial fibrillation using radiofrequency energy. Ann Thorac Surg, 2001, 71 (6):1939-1944.
  9. 9.  Melo J, Adragão P, Neves J, et al. Surgery for atrial fibrillation using radiofrequency catheter ablation:assessment of results at one year. Eur J Cardiothorac Surg, 1999, 15 (6):851-854.
  10. 10.  Stulak JM, Sundt TM 3rd, Dearani JA, et al. Ten-year experience with the Cox-maze procedure for atrial fibrillation:how do we define success? Ann Thorac Surg, 2007, 83 (4):1319-1324.
  11. 11.  Anné W, Willems R, Roskams T, et al. Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation. Cardiovasc Res, 2005, 67 (4):655-666.
  12. 12.  Casaclang-Verzosa CF, Bernard JA. Structural and functional  remodeling of the left atrium:clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol, 2008, 51 (1):1-11.
  13. 13.  Kainuma S, Masai T, Yoshitatsu M, et al. Advanced left-atrial fibrosis is associated with unsuccessful maze operation for valvular atrial fibrillation. Eur J Cardiothorac Surg, 2011, 40 (1):61-69.
  14. 14.  Schoonderwoerd BA, Van Gelder IC, Van Veldhuisen DJ, et al. Electrical and structural remodeling:role in the genesis and maintenance of atrial fibrillation. Prog Cardiovasc Dis, 2005, 48 (3):153-168.
  15. 15.  Vest JA, Wehrens XH, Reiken SR, et al. Defective cardiac ryanodine  receptor regulation during atrial fibrillation. Circulation, 2005, 111 (16):2025-2032.
  16. 16.  Li D, Melnyk P, Feng J, et al. Effects of experimental heart failure on atrial cellular and Ionic electrophysiology. Circulation, 2000, 101 (22):2631-2638.
  17. 17.  Kout SE, Lam RS, Seebohm G, et al. Modulation of human Kv1. 5 channel kinetics by N-cadherin.Biochem Biophys Res Commun, 2007, 363 (1):18-23.
  18. 18.  Everett TH 4th, Li H, Mangrum JM, et al. Electrical, morphological, and ultrastructural remodeling and reverse remodeling in a canine model of chronic atrial fibrillation. Circulation, 2000, 102 (12):1454-1460.
  19. 19.  Everett TH, Wilson EE, Verheule S, et al. Structural atrial remodeling  alters the substrate and spatiotemporal organization of atrial fibrillation:  a comparison in canine models of structural and electrical atrial remod-  eling. Am J Physiol Heart Circ, 2006, 291 (6):H2911-H2923.
  20. 20.  Nademanee K, Schwab MC, Kosar EM, et al. Clinical outcomes of catheter substrate ablation for high-risk patients with atrial fibrillation. J Am Coll Cardiol, 2008, 51 (8):843-849.
  21. 21.  Benussi S, Nascimbene S, Calori G, et al. Surgical ablation of atrial fibrillation with a novel bipolar radiofrequency device. Thorac  Cardiovasc Surg, 2005, 130 (2):491-497.