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目的研究在进行基础瓣膜置换或成形手术时附加左房减容和直流电复律术对瓣膜病合并心房颤动(简称房颤)患者房颤的影响。方法选取有心脏瓣膜病变且合并左房扩大病例298例,均伴有诊断明确的房颤病史,根据左房内径大小分成Ⅰ、Ⅱ、Ⅲ3组:左房内径40～59mm为Ⅰ组,共83例,60～79mm为Ⅱ组,共161例,80mm以上为Ⅲ组,共54例。按照住院号单双数随机将三组又分为2个亚组行瓣膜手术附加左房减容术和直流电转复为a组,未附加手术为b组;左房减容包括左房折叠和左房壁切除,直流电电转复包括电复律,起始量为10J,依次10J累加,最大达30J。如果a组自动复跳为窦性心律,依然加10J电击一次。所有病例均于术前口服可达龙并术后维持治疗。结果Ⅰa组和Ⅰb组术后早期和出院时的窦性转复率无明显差异,但随访9～12个月,Ⅰa组的窦性转复率明显高于Ⅰb组(35.3%vs28.6%P(0.05);Ⅱ组和Ⅲ组中a亚组的窦性转复率在术后早期、出院时以及随访期间均明显高于b亚组。Ⅰa组与在出院和随访期间窦性转复率高于Ⅱa、Ⅲa(44.1%vs34.4%、27.3%;35.3%vs30.0%、12.1%,P均(0.05),Ⅱa组在出院和随访期间窦性转复率亦高于Ⅲa组(34.4%vs27.3%;30.0%vs12.1%,P(0.05)。结论对于左房扩大的瓣膜病变伴房颤患者,在进行基础瓣膜置换或成形手术时附加左房减容和直流电复律手术,可以达到一个非常理想的房颤转复率和维持率,但左房内径达80mm以上的病例其远期效果不佳。
Objective To study the effects of left atrium volume reduction and DCR on atrial fibrillation in patients with valvular heart disease complicated with atrial fibrillation during basic valve replacement or shaping surgery. Methods A total of 298 patients with valvular heart disease and enlarged left atrium were enrolled in this study. All patients were diagnosed with a history of atrial fibrillation. According to the size of the left atrium, they were divided into Ⅰ, Ⅱ and Ⅲ groups. Cases, 60 ~ 79mm for the group Ⅱ, a total of 161 cases, 80mm above for the group Ⅲ, a total of 54 cases. According to the number of hospitalized patients with a single double-digit random three groups were divided into two subgroups of valve surgery additional left atrial volume reduction and DC into a group without additional surgery for the b group; left atrial volume reduction, including left atrial fold and Left atrial wall resection, DC electrical recovery, including cardioversion, the initial amount of 10J, followed by 10J cumulative up to 30J. If a group automatically jump to sinus rhythm, still plus 10J shock once. All cases were orally administered up to the surgery and maintained after surgery. Results There was no significant difference in sinus revascularization between group Ⅰa and group Ⅰb after operation and at discharge. However, the recurrence rate of group Ⅰa was significantly higher than that of group Ⅰb at the follow-up of 9-12 months (35.3% vs 28.6% P (0.05). The sinus node metastasis rate in group a and group a was significantly higher than that in group b at early postoperative period, at discharge, and at follow-up The rates of sinus metastasis in group Ⅱa during discharge and follow-up were also higher than those in group Ⅲa (Ⅱ), Ⅲa (44.1% vs 34.4%, 27.3%, 35.3% vs 30.0%, 12.1%, P <0.05) (34.4% vs27.3%, 30.0% vs12.1%, P (0.05)) .Conclusion In the patients with left atrial enlargement valvular disease accompanied with atrial fibrillation, left atrial volume reduction and DC reposition Surgery, can achieve a very good rate of recovery and maintenance of atrial fibrillation, but the left atrial diameter of 80mm or more cases of its long-term effect is not good.