Adragão Pedro, Machado Francisco Pereira, Aguiar Carlos, Parreira Leonor, Cavaco Diogo, Ribeiras Regina, Bonhorst Daniel, Queiróz e Melo João, Seabra-Gomes Ricardo
Serviço de Cardiologia, Hospital Santa Cruz, Carnaxide.
Rev Port Cardiol. 2003 Sep;22(9):1025-36.
The association between atrial fibrillation (AF) and mitral valve disease is frequent. Isolation of the pulmonary veins by radiofrequency energy applications performed intraoperatively has been proposed for patients with AF in whom mitral valve surgery has been indicated. Balloon mitral valvuloplasty is currently the preferred procedure for patients with mitral stenosis and a favorable valve anatomy.
To evaluate the short- and long-term results of percutaneous pulmonary vein isolation for the treatment of AF in patients with mitral stenosis undergoing balloon mitral valvuloplasty.
Five patients (four male and one female, age 43 +/- 4 years) underwent balloon mitral valvuloplasty concomitant with pulmonary vein isolation between August 1996 and February 1997. These patients had permanent AF, diagnosed 31 +/- 12 months previously; their mitral valve area was 1.0 +/- 0.25 cm2 and their left atria measured 54 +/- 5 mm. Balloon mitral valvuloplasty was performed via a transseptal approach, and then four ablation lines were created in the left atrial posterior wall to encircle all four pulmonary veins. Radiofrequency applications lasted 45 seconds each, and aimed at a maximum preset temperature of 65 degrees C. Electrical cardioversion was performed at the end of the procedure.
Mitral valve area increased 1.0 +/- 0.3 cm2 after valvuloplasty. The number of radiofrequency applications per patient was 37 +/- 3, and the average duration of the entire treatment was 131 +/- 28 minutes. Fluoroscopy time averaged 32 +/- 12 minutes. All patients were discharged in sinus rhythm, and mitral flow Doppler evaluation at one month showed a biphasic pattern in all cases, with the A wave measuring 70 +/- 15 cm/sec. Three patients maintained sinus rhythm at five-year follow-up. Of these patients, one had developed a left atrial flutter at four-year follow-up and underwent ablation. The remaining two patients presented AF at five year follow-up.
Percutaneous isolation of the pulmonary veins concomitant with balloon mitral valvuloplasty had suppressed AF in 60% of patients by five-year follow-up.
心房颤动（AF）与二尖瓣疾病之间的关联很常见。对于已表明需要进行二尖瓣手术的房颤患者，有人提出术中通过射频能量应用来隔离肺静脉。对于二尖瓣狭窄且瓣膜解剖结构良好的患者，球囊二尖瓣成形术目前是首选的治疗方法。
评估在接受球囊二尖瓣成形术的二尖瓣狭窄患者中，经皮肺静脉隔离治疗房颤的短期和长期效果。
1996年8月至1997年2月期间，5例患者（4例男性，1例女性，年龄43±4岁）接受了球囊二尖瓣成形术并同时进行肺静脉隔离。这些患者患有永久性房颤，在术前31±12个月被诊断出来；他们的二尖瓣面积为1.0±0.25平方厘米，左心房直径为54±5毫米。通过经房间隔途径进行球囊二尖瓣成形术，然后在左心房后壁创建四条消融线以环绕所有四条肺静脉。每次射频应用持续45秒，目标最高预设温度为65摄氏度。手术结束时进行电复律。
二尖瓣成形术后二尖瓣面积增加了1.0±0.3平方厘米。每位患者的射频应用次数为37±3次，整个治疗的平均持续时间为131±28分钟。透视时间平均为32±12分钟。所有患者均以窦性心律出院，术后1个月的二尖瓣血流多普勒评估显示所有病例均为双相模式，A波速度为70±15厘米/秒。3例患者在5年随访时维持窦性心律。在这些患者中，1例在4年随访时发生左心房扑动并接受了消融治疗。其余2例患者在5年随访时出现房颤。
到5年随访时，经皮肺静脉隔离联合球囊二尖瓣成形术使60%的患者房颤得到抑制。
