风湿性心脏病合并慢性心房颤动的射频消融治疗外科学专业论文.docxVIP

ABSTRACTBackground：It ABSTRACT Background：It remains unclear whether concomitant radiofrequency ablation procedure in valvular surgery could offer additional benefits to patients with rheumatic valvular disease．We designed a prospective and randomized control study to evaluate the efficacy of surgical radiofrequency ablation in patients with rheumatic heart disease． Methods：From June 2008 to July 20 1 1，2 1 0 patients with chronic atrial fibrillation and rheumatic heart disease were randomized：(1)control group， patients underwent only valve replacement followed by amiodarone for rhythm control，(2)left atrial group(LA group)，patients underwent valve replacement and left atrial mono-polar radiofrequency ablation，(3)Bi-atrial group(BA group)，patients underwent valve replacement and bi—atrial mono。polar radiofrequencyablation．Theprimaryendpointsincluded：cardiacdeath，stroke， and recurrent AF after discharge． Results：There was no perioperative death．One patient died 4 months after MVR in BA group．In univariate Cox analysis，the two ablation groups were associated with less AF(BA group VS control group：P0．00 1；LA group VS control group：P0．001、as well as atrial tachycardia arrhythmia 0蚯|Ⅺ|妪U recurrent(BA group VS control group：P0．00 1；LA group VS control group： P=0。02)．The comparison between BA and LA group revealed no differences in terms of AF(P--0．06)or AF／AT／AFL(P=0．09)．Atrial transport function restoration rate 1 2 months after operation was 3 1．4％in LA group．32．9％in BA group，and 8．6％in control group respectively(P0．o 1)． Conclusions：Radiofrequency ablation concurring with valvular surgery can bring a higher sinus rhythm restoration rate when compared with medical anti—arrhythmic drug therapy in low-medium risk rheumatic heart disease． 4 万方数据 第一部分实验设计研究背景和目的 第一部分实验设计 研究背景和目的 1．1背景 在临床实践中，房颤(AF)是最常见的心律不齐。普通人群中房颤的患病率 大约为l％。60岁人群中房颤的患病率为2％，超过80岁人群中房颤的患病率 为8％。Framingham的研究 已经表明，从1950年到1980年，特别是在男性人 群中，房颤的患病率出现增加。房颤的病因很多，但在超过80％的患者中是由 二尖瓣疾病引起的。随着65岁以上人口的增加，房颤的发生率可能出现进一步 升高