Efficacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease: a randomized trial
Efficacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease: a randomized trial
复制标题
导管消融和 CryoMaze 外科手术对长期持续性房颤和风湿性心脏病患者的疗效：一项随机试验。
DOI：
10.1093/eurheartj/ehq201
复制
发表时间：
2010-11-01
影响因子：
39.3
通讯作者：
Gu, Jia-Ning
中科院分区：
文献类型：
--
作者：
Liu, Xu;Tan, Hong-Wei;Gu, Jia-Ning
旨在
导管消融术和外科迷宫术是治疗房颤的有效方法。然而，尚无研究比较瓣膜手术后环肺静脉电隔离（CPVI）联合基质消融与同期迷宫手术治疗风湿性心脏病（RHD）患者房颤的效果。本研究的目的是比较CPVI联合基质改良和外科迷宫手术使用生理盐水灌注冷却尖端射频消融（SICTRA）系统治疗风心病患者长期持续性房颤的有效性。
方法和结果
2006年1月至2008年6月，将99例持续性房颤合并风心病患者随机分为两组：A组49例，行瓣膜手术，术后6个月行CPVI联合基质改良术; B组50例，行瓣膜手术，同时行迷宫术。A组和B组的平均随访期分别为15 ± 5和20 ± 8个月。一次手术后，与A组相比，B组的无房性心律失常率显著更高（B组为82%，A组为55.2%，P < 0.001）。A组15例患者接受了再次手术。B组6例患者接受导管消融，4例成功治疗。A组窦性心律累积率为71%，B组为88%（P < 0.001）。
结论
在治疗长期持续性AF和RHD患者时，使用SICTRA的同步考克斯迷宫手术比随后的CPVI联合底物改良更有效。
AIMS
Catheter ablation and surgical Maze procedure are effective in treating atrial fibrillation (AF) patients. However, there is no study that compares the effect of circumferential pulmonary vein isolation (CPVI) combined with substrate ablation after valvular surgery and the concomitant Maze procedure for the treatment of AF in patients with rheumatic heart disease (RHD). The aim of this study was to compare the effectiveness of CPVI combined with substrate modification and surgical Maze procedure using Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) system for the treatment of long-lasting persistent AF in patients with RHD.
METHODS AND RESULTS
Between January 2006 and June 2008, 99 patients with long-lasting persistent AF and RHD were randomly assigned to undergo valvular operation and CPVI combined with substrate modification 6 months after the surgery (Group A, 49 patients) or valvualr operation and concomitant Maze procedure (Group B, 50 patients). The mean follow-up periods were 15 ± 5 and 20 ± 8 months in Groups A and B, respectively. After one procedure, Group B had a significantly higher freedom from artial arrhythmias compared with Group A (82% in Group B vs. 55.2% in Group A, P < 0.001). Fifteen patients in Group A underwent a redo procedure. Six patients in Group B underwent catheter ablation and four were treated successfully. The cumulative rates of sinus rhythm were 71% in Group A and 88% in Group B (P < 0.001).
CONCLUSION
The concomitant Cox Maze procedure using SICTRA is more effective than subsequent CPVI combined with substrate modification in treating patients with long-lasting persistent AF and RHD.