非体外循环下冠状动脉旁路移植术同期心房颤动迷宫手术的疗效及安全性分析
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摘要
目的:探讨非体外循环下冠状动脉旁路移植术(OPCABG)同期行肺静脉心房颤动射频消融手术的疗效及安全性。方法:选取本院2013年3月至2018年6月收治的119例OPCABG同期心房颤动迷宫手术患者临床资料展开分析,男性82例,女性37例,平均年龄(65±3.5)岁,冠状动脉单支病变12例,多支病变107例,左主干病变26例,术前心房颤动平均时间(22±5.5)个月,其中阵发性心房颤动35例,持续性心房颤动84例。进行OPCABG术,再用双极射频设备行左右肺静脉电隔离术,左心耳结扎。结果:119例患者人均旁路移植(2.2±1.2)根,其中乳内动脉86根。患者心房颤动射频时间为(12±2.2)min,患者平均术后住院时间为(7±2.6)d。术后窦性心律72例(60.5%)、结性心律8例(6.8%)、心房颤动心律39例(32.7%)。术后随访97例,随访(26±3.5)个月,其中发现窦性心律维持者65例(67.1%)、心房颤动心律者32例(32.9%)阵发性心房颤动术后及随访窦性心律比率高于持续性心房颤动治疗效果。结论:OPCABG术同期进行肺静脉心房颤动射频消融手术安全,心房颤动转复及窦性心律维持率良好。
Objective: To explore the efficacy and safety of radiofrequency ablation of pulmonary venous for atrial fibrillation undergoing off-pump coronary artery bypass grafting(OPCABG). Methods: From March 2013 to June 2018 119 cases of OPCABG with concomitant pulmonary vein ablation for atrial fibrillation were operated in our hospital. Including male 82, female 37 cases, average age(65±3.5) years old, 12 cases were single coronary artery lesions, 107 cases were multi-vessel lesions, 26 cases were left main lesion, preoperative duration of atrial fibrillation were(22±5.5) months, 35 cases were paroxysmal atrial fibrillation and 84 cases were persistent atrial fibrillation respectively, A bipolar radiofrequency device was isolated for left and right pulmonary veins after OPCABG,then the left auricle was ligated. Results: Of the 119 patients, the average number of bypass grafts were(2.2±1.2), 86 case with left internal mammary artery. Radiofrequency atrial fibrillation average time were(12±2.2) min and the mean postoperative hospital stay were(7±2.6) days. After operation, there were 72 cases of sinus rhythm(60.5%), 8 cases of nodal rhythm(6.8%) and 39 cases of atrial fibrillation rhythm(32.7%). Postoperative follow-up was performed in 97 patients for(26±3.5) months, among which 65 patients(67.1%) were found with sinus rhythm maintenance and 32 patients with atrial fibrillation rhythm(32.9%). The rate of sinus rhythm of radiofrequency ablation for paroxysmal atrial fibrillation and follow-up was better than that of persistent atrial fibrillation. Conclusions: Radiofrequency ablation of pulmonary venous for atrial fibrillation undergoing OPCABG is a safe and available procedure. Its recovery and the maintenance of sinus rhythm are favorable.
Objective: To explore the efficacy and safety of radiofrequency ablation of pulmonary venous for atrial fibrillation undergoing off-pump coronary artery bypass grafting(OPCABG). Methods: From March 2013 to June 2018 119 cases of OPCABG with concomitant pulmonary vein ablation for atrial fibrillation were operated in our hospital. Including male 82, female 37 cases, average age(65±3.5) years old, 12 cases were single coronary artery lesions, 107 cases were multi-vessel lesions, 26 cases were left main lesion, preoperative duration of atrial fibrillation were(22±5.5) months, 35 cases were paroxysmal atrial fibrillation and 84 cases were persistent atrial fibrillation respectively, A bipolar radiofrequency device was isolated for left and right pulmonary veins after OPCABG,then the left auricle was ligated. Results: Of the 119 patients, the average number of bypass grafts were(2.2±1.2), 86 case with left internal mammary artery. Radiofrequency atrial fibrillation average time were(12±2.2) min and the mean postoperative hospital stay were(7±2.6) days. After operation, there were 72 cases of sinus rhythm(60.5%), 8 cases of nodal rhythm(6.8%) and 39 cases of atrial fibrillation rhythm(32.7%). Postoperative follow-up was performed in 97 patients for(26±3.5) months, among which 65 patients(67.1%) were found with sinus rhythm maintenance and 32 patients with atrial fibrillation rhythm(32.9%). The rate of sinus rhythm of radiofrequency ablation for paroxysmal atrial fibrillation and follow-up was better than that of persistent atrial fibrillation. Conclusions: Radiofrequency ablation of pulmonary venous for atrial fibrillation undergoing OPCABG is a safe and available procedure. Its recovery and the maintenance of sinus rhythm are favorable.
引文
[1] 庞中一,谢海秀,章晔,等.心房颤动患者左心房及左心耳血栓形成的危险因素分析[J].心肺血管病杂志,2017,36(3): 185-189.
[2] Robertson JO, Lawrance CP, Maniar HS, et al. Surgical techniques used for the treatment of atrial fibrillation[J]. Circ J, 2013, 77 (8):1941-1951.
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[6] Campos C M, Van Klaveren D, Farooq V, et al. Long-term forecasting and comparison of mortality in the evaluation of the xience everolimus eluting stent vs. coronary artery bypass surgery for effectiveness of left main revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II[J]. Eur Heart J, 2015, 36(20): 1231-1241.
[7] Lamy A, Devereaux P J, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting[J]. N Engl J Med, 2016, 375(24): 2359-2368.
[8] Aldea G S, Bakaeen F G, Pal J, et al. The society of thoracic surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting [J]. Ann Thoracic Surg, 2016, 101(2): 801-809.
[9] S Potpara T, YH Lip G. A brief history of ‘lone’atrial fibrillation: from ‘a peculiar pulse irregularity’to a modern public health concern [J]. Curr Pharma Des, 2015, 21(5): 679-696.
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[11] January C T, Wann L S, Alpert J S, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society[J]. J Am Coll Cardiol, 2014, 64(21): e1-e76.
[12] Haissaguerre M, Shah A J, Cochet H, et al. Intermittent drivers anchoring to structural heterogeneities as a major pathophysiological mechanism of human persistent atrial fibrillation[J]. J Physiol, 2016, 594(9): 2387-2398.
[13] Mahajan R, Lau D H, Brooks A G, et al. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity [J]. J Am Coll Cardiol, 2015, 66(1): 1-11.
[14] Heijman J, Voigt N, Nattel S, et al. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression [J]. Cir Res, 2014, 114(9): 1483-1499.
[15] Miller J M, Kowal R C, Swarup V, et al. Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry[J]. J Cardiovasc Electrophysiol, 2014, 25(9): 921-929.
[16] Henn M C, Lancaster T S, Miller J R, et al. Late outcomes after the Cox maze IV procedure for atrial fibrillation [J]. J Thorac Cardiov Sur, 2015, 150(5): 1168-1178. e2.
[17] Je H G, Shuman D J, Ad N. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy [J]. Eur J Cardio-Thoracic Surg, 2015, 48(4): 531-541.
[18] Philpott J M, Zemlin C W, Cox J L, et al. The ABLATE trial: safety and efficacy of Cox maze-IV using a bipolar radiofrequency ablation system[J]. Ann Thoracic Surg, 2015, 100(5): 1541-1548.
[19] 张润生. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究[J]. 中外医学研究, 2015, 13(20): 49-51.
[20] Soni L K, Cedola S R, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity[J]. J Thoracic Cardiovasc Surg, 2013, 145(2): 356-363.
[21] 姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究[J]. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.
[2] Robertson JO, Lawrance CP, Maniar HS, et al. Surgical techniques used for the treatment of atrial fibrillation[J]. Circ J, 2013, 77 (8):1941-1951.
[3] Velazquez E J, Lee K L, Jones R H, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy[J]. N Engl J Med, 2016, 374(16): 1511-1520.
[4] Stone G W, Sabik J F, Serruys P W, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease[J]. N Engl J Med, 2016, 375(23): 2223-2235.
[5] 金琪琳,王丕杉,曹向戎. 不停跳冠状动脉移植术后心房颤动危险因素分析[J].心肺血管病杂志, 2018,37(5): 429-431.
[6] Campos C M, Van Klaveren D, Farooq V, et al. Long-term forecasting and comparison of mortality in the evaluation of the xience everolimus eluting stent vs. coronary artery bypass surgery for effectiveness of left main revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II[J]. Eur Heart J, 2015, 36(20): 1231-1241.
[7] Lamy A, Devereaux P J, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting[J]. N Engl J Med, 2016, 375(24): 2359-2368.
[8] Aldea G S, Bakaeen F G, Pal J, et al. The society of thoracic surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting [J]. Ann Thoracic Surg, 2016, 101(2): 801-809.
[9] S Potpara T, YH Lip G. A brief history of ‘lone’atrial fibrillation: from ‘a peculiar pulse irregularity’to a modern public health concern [J]. Curr Pharma Des, 2015, 21(5): 679-696.
[10] Gourdie R G, Dimmeler S, Kohl P. Novel therapeutic strategies targeting fibroblasts and fibrosis in heart disease[J]. Nat Rev Drug Dis, 2016, 15(9): 620.
[11] January C T, Wann L S, Alpert J S, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society[J]. J Am Coll Cardiol, 2014, 64(21): e1-e76.
[12] Haissaguerre M, Shah A J, Cochet H, et al. Intermittent drivers anchoring to structural heterogeneities as a major pathophysiological mechanism of human persistent atrial fibrillation[J]. J Physiol, 2016, 594(9): 2387-2398.
[13] Mahajan R, Lau D H, Brooks A G, et al. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity [J]. J Am Coll Cardiol, 2015, 66(1): 1-11.
[14] Heijman J, Voigt N, Nattel S, et al. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression [J]. Cir Res, 2014, 114(9): 1483-1499.
[15] Miller J M, Kowal R C, Swarup V, et al. Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry[J]. J Cardiovasc Electrophysiol, 2014, 25(9): 921-929.
[16] Henn M C, Lancaster T S, Miller J R, et al. Late outcomes after the Cox maze IV procedure for atrial fibrillation [J]. J Thorac Cardiov Sur, 2015, 150(5): 1168-1178. e2.
[17] Je H G, Shuman D J, Ad N. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy [J]. Eur J Cardio-Thoracic Surg, 2015, 48(4): 531-541.
[18] Philpott J M, Zemlin C W, Cox J L, et al. The ABLATE trial: safety and efficacy of Cox maze-IV using a bipolar radiofrequency ablation system[J]. Ann Thoracic Surg, 2015, 100(5): 1541-1548.
[19] 张润生. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究[J]. 中外医学研究, 2015, 13(20): 49-51.
[20] Soni L K, Cedola S R, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity[J]. J Thoracic Cardiovasc Surg, 2013, 145(2): 356-363.
[21] 姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究[J]. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.