Nakayama Yoshio, Ueda T, Hamada Y, Kawata T
Department of Cardiovascular Surgery, Takai Hospital, Tenri, Japan.
Kyobu Geka. 2007 Jun;60(6):449-52.
We evaluated the effectiveness of pulmonary vein isolation (PVI) with bipolar radiofrequency ablation in prevention of atrial fibrillation during the acute postoperative period following open-heart surgery. Twenty-six patients with paroxysmal atrial fibrillation (PAF) underwent elective open-heart surgery combined with PVI using bipolar radiofrequency ablation from October 2004 to January 2006. They consisted of 17 male and 9 female with the mean age of 64.2 +/- 8.6 years. Their structural heart disease included coronary artery disease, aortic valve disease, and mitral valve disease. PVI was performed on the bilateral pulmonary vein antra under beating heart using cardiopulmonary bypass. The bipolar radiofrequency system included Atricure (n = 19) and Cardioblate (n = 7). There was no operative death nor complication related to bipolar radiofrequency ablation. In principle, no anti-arrhythmic drugs except beta-blockades were administered postoperatively. In 24 of 26 (92.3%) patients, the sinus rhythms were restored without PAF during the 2 week postoperative period. Even in cases with preoperative PAF, PVI was effective in preventing atrial fibrillation during the acute phase following open-heart surgery. We suggest that bipolar radiofrequency ablation is an alternative procedure to prevent atrial fibrillation in open-heart surgery.
我们评估了双极射频消融肺静脉隔离术在心脏直视手术后急性期预防房颤的有效性。2004年10月至2006年1月,26例阵发性房颤(PAF)患者接受了择期心脏直视手术并联合使用双极射频消融进行肺静脉隔离术。他们包括17名男性和9名女性,平均年龄为64.2±8.6岁。他们的结构性心脏病包括冠状动脉疾病、主动脉瓣疾病和二尖瓣疾病。在心脏跳动下使用体外循环对双侧肺静脉前庭进行肺静脉隔离术。双极射频系统包括Atricure(n = 19)和Cardioblate(n = 7)。没有与双极射频消融相关的手术死亡或并发症。原则上,术后除β受体阻滞剂外不使用抗心律失常药物。26例患者中有24例(占92.3%)在术后2周内恢复窦性心律且无房颤发作。即使是术前有PAF的病例,肺静脉隔离术在心脏直视手术后急性期预防房颤也有效。我们认为双极射频消融是心脏直视手术中预防房颤的一种替代方法。