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find Keyword "房颤" 207 results
  • Amiodarone for Atrial Fibrillation

    目的:研究胺碘酮治疗心房颤动的疗效。方法:用胺碘酮治疗心房颤动患者68例(阵发性心房颤动40例,持续性心房颤动28例)。结果:连续用药治疗6个月显示治疗有效率分别为925%、75%。治疗12个月有效率分别为853%、68%。结论:胺碘酮治疗心房颤动安全有效,副作用小,可作为首选药。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • Influence of Preoperative Left Atrial Dimension on the Effectiveness of Surgical Radiofrequency Ablation for Treatment  of Atrial Fibrillation

    Abstract: Objective To analyze the influence of preoperative left atrial dimension (LAD) on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation (AF) through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD:Group A, 75 patients with their LAD<50 mm, including 22 males and 53 females with their average age of 56.50±10.05 years;Group B, 89 patients with their LAD ranging from 50 to 60 mm, including 32 males and 57 females with their average age of 55.63±10.28 years;Group C, 117 patients with their LAD ranging from 60 to 70 mm, including 41 males and 76 females with their average age of 55.13±10.96 years;and Group D, 152 patients with their LAD>70 mm, including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery, before discharge, at 6 months and 1,2,3,4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery(P=0. 011), before discharge(P=0. 002), at 6 months(P< 0. 001) and 1 year (P<0. 001), 2 years(P<0. 001), 3 years(P<0. 001), 4 years(P<0. 001) and 5 years(P= 0. 006) during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1,2,3, 4 and 5 years during follow-up was 90.4%, 89.9%, 90.3%, 91.3%, 89.1%, and 90.9% in Group A, 80.2%,79.0%,78.1%, 76.1%,72.5%,70.0% in Group B,74.7%,74.0%,71.2%,72.4%,70.0%, and 64.7% in Group C, and 61.8%,57.6%,56.8%,53.9%,50.7%,and 48.6% in Group D, respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Comparison of Clinical Outcomes of Two Different Radiofrequency Ablation for the Treatment of Permanent Atrial Fibrillation of Patients with Rheumatic Valvular Heart Disease

    Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency (RF) ablation for the treatment of permanent atrial fibrillation(AF) of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros- pectively analyzed. According to different RF ablation methods,all the 124 patients were divided into bipolar group and unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years,and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating,the very postoperative day,7 days,1 month,3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time(70.05±22.02 min vs. 54.47±20.65 min,P=0.025) and RF ablation time(25.12±3.00 min vs. 15.70±3.02 min,P=0.000)of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating,the lst and 7th day after operation, sinus rhythm restoration rates were 88.71%,87.10%,80.65% respectively in the bipolar group,85.48%,77.42%,72.58% respectively in the unipolar group,and there was no statistical difference between the two groups (P>0.05). In the 1st,3rd and 6th postoperative month,sinus rhythm restoration rates of the bipolar group (79.03%,75.81%,72.58% respectively) were significantly higher than those of the unipolar group (59.68%,50.00%,48.38% respectively,P<0.05). Conclusion Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique,while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Accuracy of Preoperative B-type Natriuretic Peptide Level in Predicting New Onset Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting:A Systematic Review

    Objective To evaluate the value of preoperative B-type natriuretic peptide (BNP) level in predicting new onset atrial fibrillation (AF) in patients after coronary artery bypass grafting (CABG). Methods We electronically searched PubMed,EMbase,Cochrane library,CNKI and VIP databases from the establishment of those databases to November 2012. Evaluation standard of diagnostic tests was used to identify and screen literatures which investigated correlations between preoperative BNP levels and new onset AF of patients after CABG. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was used to evaluate study quality of included literatures. RevMan 5.0 was used for heterogeneity test. Meta-Disc 1.4 software was used for meta-analysis. Included studies were weighted and then combined. Sensitivity,specificity,diag- nostic odds ratio (DOR),positive likelihood ratio,negative likelihood ratio and corresponding 95% confidence interval(95% CI)were calculated. Summary receiver operating characteristic (SROC) curve was drawn,and the area under the SROC curve (AUC) was analyzed. Results A total of 236 studies were identi?ed,and 5 studies met the eligibility criteria including 802 patients for analysis. There were 228 patients with postoperative new onset AF,and 574 patients without postoperative AF. The quality of the included literature was relatively high. DOR of preoperative elevated BNP level with postoperative new onset AF was 4.15 with 95% CI 2.90 to 5.95. Pooled sensitivity was 0.78 with 95% CI 0.72 to 0.83,pooled specificity was 0.58 with 95% CI 0.54 to 0.58,pooled positive likelihood ratio was 1.91 with 95% CI 1.42 to 1.56,pooled negative likelihood ratio was 0.42 with 95% CI 0.32 to 0.54,and the AUC of SROC was 0.79 (Q=0.72). Conclusion Preoperative elevated BNP level is significantly correlated with new onset AF after CABG,is a powerful predictor of postoperative AF,and can be used to predict new onset AF after CABG to a certain extent of reliability.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Preoperative Oral Amiodarone for the Prevention of Atrial Fibrillation after Coronary Artery Bypass Grafting in Patients Older Than 70 Years

    Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB) in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective,double-blind and placebo controlled study. Preoperatively,all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group,there were 80 patients including 38 male and 42 female patients who were given oral amiodarone (trade name: Cordarone) 200 mg,three times a day,3-5 days before surgery,and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days,and total amiodarone dosage was 2.6±0.5 g. In the control group,there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule,and preoperative duration of placebo intake was 4.0±1.4 days. Operation time,graft number,postoperative AF incidence,AF duration,hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number,operation time,AF duration of patients who had postoperative AF,or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group [18.7% (15/80) vs. 34.2% (26/76),P=0.028]. Seventy-three patients in the amiodarone group (91.3%) and 66 patients in the control group (86.8%) were followed up for 8-24 months. During follow-up,2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups [6.8% (5/73) vs. 6.1% (4/66),P=0.860] .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Clinical Analysis of Concomitant Mitral Valve Replacement and Bipolar Radiofrequency Ablation for Chronic AtrialFibrillation

    Objective To evaluate clinical results of concomitant mitral valve replacement (MVR) and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation (AF). Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 (48±11) years. The AF duration was 1.2-26.0 (7.2±3.4) years. Preoperatively,there were 20 patients with New York Heart Association (NYHA) class Ⅱ,31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis,9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 (55.2±8.9) mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass (CPB) with beating heart first,then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 (99±28)minutes,aortic cross-clamping time was 46-123 (69±17)minutes,and ablation time was 15-28 (21±4)minutes. Postoperatively,heart rhythm immediately changed to sinus rhythm (SR) in 44 patients,remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia (3 patients recovered SR and 1 patient remained AF later). Fifty-eight patients were followed up after discharge for 6-33 months,and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % (50/58),91.4% (53/58),89.7 % (52/58),84.6 % (33/39)and 71.4 % (5/7)at discharge,3 months,6 months,1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Outcomes of Maze Procedure Using Bipolar Radiofrequency Ablation for Surgical Treatment of Permanent Atrial Fibrillation

    Abstract: Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation(AF) and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was(56.1±47.1) months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was(43.8±25.6) months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass(CPB)time, aortic cross-clamping(ACC)time, mechanical ventilation time, intensive care unit(ICU) length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different (P>0.05). The CPB time and ACC time between the two groups were not statistically different (P> 0.05). The postoperative hospital stay of ablation group was significantly longer than that of control group (15.8±6.1 d vs. 12.9±3.1d,P=0.001). No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group(59.6%±9.2% vs. 55.5%±5.4%,P< 0.01). The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87.5%, 87.1% and 82.4% respectively, 3.3%, 2.2%, 0.0%, and 0.0% in control group respectively, which was statistically different between the two groups(P< 0.05). Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve Replacement

    Abstract: Objective To determine the influence of preoperative atrial fibrillation (AF) on midterm and longterm clinical outcomes of patients after mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital, Second Military Medical University, from January 2000 to December 2005. According to the exclusion criteria, 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group, including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm (SR) were in the SR group, including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes, midterm and longterm mortality and morbidity of the two groups were compared. Results During 10 years of follow-up, there was no statistical difference in early postoperative mortality and morbidity between the two groups, but the incidence of late thromboembolism was significantly higher in AF group than that in SR group [0.9‰ (31 patients/33 984 patient-months) vs. 0.4‰ (9 patients/21 151 patient-months), χ2=4.26, P=0.039]. Ten-year survival rate in patients in AF group was significantly lower than that in SR group (83.2% vs. 92.7%, χ2=10.26, P=0.002). Multivariate analysis identified preoperative AF [HR=2.878, 95% CI (1.166,4.129)], low left ventricular ejection fraction [HR=0.948, 95% CI (0.917,0.981)] , and old age [HR=1.073, 95% CI (1.038,1.109)] as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism, preoperative AF also had an adverse effect on left ventricular function, right ventricular function and tricuspid regurgitation. Conclusion AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 改良冲洗式双极射频消融手术治疗心房颤动

    目的 分析心瓣膜置换术中同期行改良冲洗式双极射频消融治疗心房颤动的临床效果。 方法 回顾性分析2009年4月至2011年6月安徽医科大学第二附属医院心瓣膜病合并心房颤动34例患者在体外循环下行心瓣膜置换术+改良冲洗式双极射频消融手术的临床资料,其中男21例,女13例;年龄41~76 (50.5±11.3)岁。风湿性心脏瓣膜病31例,心瓣膜退行性病变3例;合并慢性持续性/永久性心房颤动27例,阵发性心房颤动7例。均采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融操作。消融手术包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融(改良Cox-mazeⅢ手术路径)和Marshall韧带切除。术后常规予胺碘酮治疗。 结果 全组无死亡,除2例术后并发Ⅲ○房室传导阻滞、安装永久性心脏起搏器外,其余患者未发生与消融相关的并发症。术后31例转为非心房颤动心律(窦性心律25例,结性心律4例,起搏心律2例),3例维持心房颤动心律。随访3~20个月,29例维持窦性心律(85.3%),3例心房颤动心律,2例起搏心律。 结论 改良冲洗式双极射频消融治疗心房颤动安全、有效。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 双极射频消融迷宫术后同步电复律治疗心房颤动

    目的 总结双极射频消融迷宫术(CoxⅣ)术后同步电复律治疗心房颤动(AF)的临床经验。 方法 2006年7月至2009年7月沈阳军区总医院对223例AF患者行CoxⅣ治疗,其中13例患者(包括男4例,女9例;年龄41~69岁;风湿性心脏病7例,退行性心瓣膜病5例,继发孔型房间隔缺损合并三尖瓣关闭不全1例)于出院后仍为AF而药物转复不佳,行同步电复律治疗。电复律后观察心率和心律情况,监测生命体征,出院后继续口服胺碘酮200 mg,1次/天,定期门诊随访。 结果 CoxⅣ手术后6个月内行同步电复律4例,即刻转复窦性心律3例;6个月以上行同步电复律9例,即刻转复窦性心律4例、AF 2例、交界性心律3例。CoxⅣ术后1年以上行电复律3例,转复窦性心律2例。13例均获随访,随访时间6个月~1年。随访期间窦性心律8例(61.54%)、AF4例(30.77%)、交界性心律1例(7.69%)。7例电复律后即刻转复为窦性心律的患者中有1例复发,窦性心律维持率为85.71%(6/7);6例即刻未转复为窦性心律患者中有2例转为窦性心律。窦性心律患者复律后左心房内径(LAD)较复律前明显减小(39.00±5.15 mm vs. 54.50±3.63 mm, t=6.958, P=0.000),而AF患者LAD在复律前后无明显改变(51.00±5.72 mm vs. 48.00±5.89 mm,t=0.731,P=0.493)。 结论 CoxⅣ手术后电复律治疗AF安全有效,成功率高,是CoxⅣ术后控制AF的重要治疗手段。复律时机以术后6个月以内为宜,即刻转复窦性心律成功率较高,维持率也高。LAD明显缩小者电复律效果较好。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
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