经皮球囊超声消融导管直视下肺静脉口消融治疗风湿性瓣膜病合并永久性心房颤动

[Ablation of the orifices of the pulmonary veins under direct vision by using the transballoon ultrasound ablation catheter for permanent atrial fibrillation with rheumatic valve disease].

作者信息

Li Li, Xu Zhi-yun, Cui Yong, Li Yuan-xin, Pei De-an

机构信息

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2007 Feb;35(2):123-6.

PMID:17445403

Abstract

OBJECTIVE

To evaluate the effect and possibility of surgical ablation of the pulmonary vein orifices under direct vision with transballoon ultrasound ablation catheter for patients with permanent atrial fibrillation and rheumatic valve disease.

METHODS

21 consecutive patients with rheumatic valve disease and permanent atrial fibrillation undergoing mitral valve replacement surgery were enrolled for this study from December 2002 to September 2003. All the cases were divided into 2 groups by whether or not receiving an additive pulmonary vein ablation procedure. The test group [6 male, 5 female, aged (51.55 +/- 7.83) years, atrial fibrillation duration (5.50 +/- 5.40) years, left atrial diameter (7.27 +/- 1.39) cm, LVEF (53.95 +/- 4.54)% and NYHA class II - IV] undertook a surgical isolation of the pulmonary vein orifices by using a transballoon ultrasound ablation catheter addition to routine mitral valve replacement. The control group [3 male, 7 female, aged (53.30 +/- 7.86) years, atrial fibrillation duration (4.50 +/- 3.47) years, left atrial diameter (6.74 +/- 0.62) cm, LVEF (56.91 +/- 3.78)% and NYHA class II - IV] received the valve replacement surgery alone.

RESULTS

There were not any complications in both groups. With an electrical cardioversion 3 months after the surgery, 73% patients in the ultrasound ablation group were free from AF over 1 year while only 10% patients in control group (P=0.003). During an average follow-up duration of (45.92 +/- 4.61) months, 63.6% were in sinus rhythm in ultrasound ablation group while none in the control group. Left atrial volume decreased significantly at 1 year after surgery compared to that at 3 months after surgery in the test group [(97.83 +/- 32.39) cm(3) vs. (150.78 +/- 52.32) cm(3), P<0.05], and the end systolic diameter (LAESD) and end diastolic diameter (LAEDD) also decreased [(4.12 +/- 0.39) cm vs. (5.09 +/- 0.98) cm, P<0.05, respectively], while there were no apparently changes in the control group.

CONCLUSIONS

Ablation of the orifices of the pulmonary veins under direct vision with transballoon ultrasound ablation catheter during mitral valve surgery seems effective to maintain sinus rhythm after electrical cardioversion and could be performed safely. The function of left atrial and cardiac output improved during long term follow-up of 46 months.

摘要

目的

评估经球囊超声消融导管直视下肺静脉口部手术消融对永久性心房颤动合并风湿性瓣膜病患者的疗效及可行性。

方法

选取2002年12月至2003年9月期间连续21例接受二尖瓣置换手术的风湿性瓣膜病合并永久性心房颤动患者纳入本研究。所有病例根据是否接受附加肺静脉消融手术分为2组。试验组[男6例，女5例，年龄（51.55±7.83）岁，房颤病程（5.50±5.40）年，左心房直径（7.27±1.39）cm，左心室射血分数（LVEF）（53.95±4.54）%，纽约心脏病协会（NYHA）心功能分级II - IV级]在常规二尖瓣置换基础上，使用经球囊超声消融导管进行肺静脉口部手术隔离。对照组[男3例，女7例，年龄（53.30±7.86）岁，房颤病程（4.50±3.47）年，左心房直径（6.74±0.62）cm，LVEF（56.91±3.78）%，NYHA心功能分级II - IV级]仅接受瓣膜置换手术。

结果

两组均未出现任何并发症。术后3个月进行电复律，超声消融组73%的患者1年以上无房颤发作，而对照组仅10%（P = 0.003）。在平均随访（45.92±4.61）个月期间，超声消融组63.6%的患者维持窦性心律，而对照组无1例。试验组术后1年左心房容积较术后3个月显著减小[（97.83±32.39）cm³对（150.78±52.32）cm³，P < 0.05]，收缩末期直径（LAESD）和舒张末期直径（LAEDD）也减小[（4.12±0.39）cm对（5.09±0.98）cm，P分别< 0.05]，而对照组无明显变化。