Pinho-Gomes Ana C, Amorim Mário J, Oliveira Sílvia M, Azevedo Luís, Almeida Jorge, Maciel Maria Júlia, Pinho Paulo, Leite-Moreira Adelino F
Department of Physiology and Cardiothoracic Surgery, University of Porto, Porto, Portugal; Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal.
J Card Surg. 2015 Jan;30(1):117-23. doi: 10.1111/jocs.12452. Epub 2014 Oct 19.
The aim of this study was to compare the results of concomitant unipolar radiofrequency ablation of nonparoxysmal atrial fibrillation (AF) between rheumatic and degenerative valve disease (RHD versus DVD).
Between 2005 and 2012, 96 patients underwent AF ablation with unipolar radiofrequency concurrently with heart valve surgery. They were followed in three months and at a median follow-up of 39 (18 to 61) months.
The mean age was 62 years old. Most patients had RHD (54.2%) and dilated left atria (LA, diameter 52.6 ± 5.8 mm). Patients with RHD were more likely to be younger and have larger LA. 88 patients (92%) underwent prophylactic closure of the left atrial appendage (LAA). Pulmonary vein-isolation, box lesion, LAA isolation, and left isthmus line were performed by radiofrequency, along with other right atrial cut-and-sew lines. Overall, surgical complications occurred in 25% of the patients and pacemaker implantation (17.7%) was the most frequently observed. In-hospital mortality rate was zero. The median length of stay was 8 (7, 12) days. Seventy-one percent of the patients were in sinus rhythm at discharge. Sinus rhythm maintenance was 45% and 40% in three months and at a median follow-up of 39 (18 to 61) months (269 patient-years), respectively. There was no statistically significant difference between RHD and DVD. In the multivariate analysis, LA ≥50 mm was the single independent predictor of AF recurrence at three months.
Radiofrequency ablation of AF concurrently with heart valve surgery is poorly effective in patients with multiple adverse risk factors. Patients with RHD and DVD had similar rates of sinus rhythm recovery. LA ≥50 mm was the single predictor of AF recurrence at three months.
本研究旨在比较风湿性与退行性瓣膜病（风湿性心脏病与退行性瓣膜病）患者同时进行非阵发性心房颤动（房颤）单极射频消融的结果。
2005年至2012年期间，96例患者在进行心脏瓣膜手术的同时接受了单极射频房颤消融术。对他们进行了3个月的随访，并进行了中位随访时间为39（18至61）个月的随访。
平均年龄为62岁。大多数患者患有风湿性心脏病（54.2%）且左心房扩大（左心房，直径52.6±5.8mm）。风湿性心脏病患者更可能较年轻且左心房更大。88例患者（92%）接受了左心耳预防性封闭术。通过射频进行肺静脉隔离、盒状病变、左心耳隔离和左峡部线消融，以及其他右心房的切割缝合线。总体而言，25%的患者发生了手术并发症，最常见的是起搏器植入（17.7%）。住院死亡率为零。中位住院时间为8（7，12）天。71%的患者出院时处于窦性心律。3个月和中位随访39（18至61）个月（269患者年）时窦性心律维持率分别为45%和40%。风湿性心脏病和退行性瓣膜病之间无统计学显著差异。在多变量分析中，左心房≥50mm是3个月时房颤复发的唯一独立预测因素。
在有多种不良风险因素的患者中，心脏瓣膜手术同时进行房颤射频消融效果不佳。风湿性心脏病和退行性瓣膜病患者窦性心律恢复率相似。左心房≥50mm是3个月时房颤复发的唯一预测因素。
