风湿性心脏病合并慢性心房颤动的射频消融治疗
发布时间：2018-09-18 17:10
【摘要】：背景：心脏瓣膜手术中对患者同时采取射频消融术,至于这些能否为风湿性心脏瓣膜病提供额外的效果目前还不清楚。我们通过前瞻性随机对照的研究来探讨射频消融术对风湿性心脏瓣膜病治疗的效果。方法：将2008年6月至2011年7月期间的210例伴有慢性房颤和风湿性心脏瓣膜病的患者随机分为以下几组：(1)对照组,该组患者在瓣膜恢复后只采取使用胺碘酮控制心律,(2)左心房组(LA组),患者在瓣膜恢复后只对左心房进行单级射频消融术,(3)双侧心房组(BA组),患者在瓣膜恢复正常后两侧心房均采取单级射频消融术。主要的指标包括：心源性死亡,中风和出院后再次出现房颤。结果：未出现围术期死亡。在BA组中一名患者在二尖瓣置换术(MVR)4个月后死亡。由考克斯单变量分析得出,在双侧心房射频消融组中出现房颤的次数较少(BA组与对照组相比,p0.001,LA组与对照组相比,p0.001),并且出现房性心动过速性心律失常(AF/AT/AFL)的次数较少(BA组与对照组相比,p0.001,LA组与对照组相比,p=0.02)。BA组与LA组相比,房颤(AF)(p=0.06)或AF/AT/AFL (p=0.09)之间没有显著性差异。手术后12个月心房传输功能恢复率LA组是31.4%,BA组是32.9%,对照组是8.6%。结论：在中低风险的风湿性心脏瓣膜疾病的治疗中,与常规医疗抗心律失常药物的治疗相比,心脏瓣膜术中射频消融术使窦性心律恢复正常的概率更大。
[Abstract]:Background: radiofrequency ablation is performed simultaneously in valvular heart surgery, but it is not clear whether these can provide additional effects for rheumatic valvular disease. We investigated the effect of radiofrequency ablation on rheumatic valvular heart disease by prospective randomized controlled study. Methods: from June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic valvular disease were randomly divided into the following groups: (1) Control group; Patients in this group were only treated with amiodarone to control heart rhythm after valve recovery, (2) left atrium group (LA group), patients underwent single stage radiofrequency ablation of left atrium after valve recovery, (3) bilateral atrium group (BA group), and patients returned to normal valve after valve recovery. Single stage radiofrequency ablation was performed on both sides of the atrium. The main indicators include cardiogenic death, stroke, and the recurrence of atrial fibrillation after discharge. Results: there was no perioperative death. In the BA group, one patient died 4 months after mitral valve replacement (MVR). By Cox's univariate analysis, Atrial fibrillation was found less frequently in the bilateral atrial radiofrequency ablation group (P 0.001) and atrial tachycardia (AF/AT/AFL) was less frequent in the BA group than in the control group (compared with the control group). BA group was compared with LA group. There was no significant difference between atrial fibrillation (AF) (p0. 06) or AF/AT/AFL (p0. 09). 12 months after operation, the recovery rate of atrial transmission function in LA group was 31.4% and that in control group was 32.9% and 8.6%, respectively. Conclusion: in the treatment of low risk rheumatic valvular disease, compared with conventional antiarrhythmic drugs, radiofrequency ablation during cardiac valve surgery has a higher probability of sinus rhythm returning to normal.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
，
本文编号：2248575
[Abstract]:Background: radiofrequency ablation is performed simultaneously in valvular heart surgery, but it is not clear whether these can provide additional effects for rheumatic valvular disease. We investigated the effect of radiofrequency ablation on rheumatic valvular heart disease by prospective randomized controlled study. Methods: from June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic valvular disease were randomly divided into the following groups: (1) Control group; Patients in this group were only treated with amiodarone to control heart rhythm after valve recovery, (2) left atrium group (LA group), patients underwent single stage radiofrequency ablation of left atrium after valve recovery, (3) bilateral atrium group (BA group), and patients returned to normal valve after valve recovery. Single stage radiofrequency ablation was performed on both sides of the atrium. The main indicators include cardiogenic death, stroke, and the recurrence of atrial fibrillation after discharge. Results: there was no perioperative death. In the BA group, one patient died 4 months after mitral valve replacement (MVR). By Cox's univariate analysis, Atrial fibrillation was found less frequently in the bilateral atrial radiofrequency ablation group (P 0.001) and atrial tachycardia (AF/AT/AFL) was less frequent in the BA group than in the control group (compared with the control group). BA group was compared with LA group. There was no significant difference between atrial fibrillation (AF) (p0. 06) or AF/AT/AFL (p0. 09). 12 months after operation, the recovery rate of atrial transmission function in LA group was 31.4% and that in control group was 32.9% and 8.6%, respectively. Conclusion: in the treatment of low risk rheumatic valvular disease, compared with conventional antiarrhythmic drugs, radiofrequency ablation during cardiac valve surgery has a higher probability of sinus rhythm returning to normal.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
，
本文编号：2248575
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