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摘要目的：分析心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的术后中远期疗效及其影响因素。方法：选取2007 年7 月至2010 年12 月于我院行心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的72 例患者，术后随访3 至6 年，获得患者术后十二导联心电图、24 h动态心电图和心脏彩超结果，并且记录术后药物应用、相关并发症、心功能恢复情况及生活质量是否改善等情况。根据心电图结果，将患者分为窦性心律组与非窦性心律组，应用统计学方法比较两组患者术前相关因素是否有差异。结果：截止至随访终点，有效随访的68 例患者中窦性心律维持率为63.2％。单因素分析显示术前房颤病程、术前左室射血分数、是否合并三尖瓣成形或置换是影响手术效果的影响因素，多因素分析显示术前房颤病程、合并三尖瓣成形或置换是影响手术效果的危险因素。结论：心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的中晚期疗效好，术后并发症少，能够有效防止血栓栓塞，术前房颤病程长、合并三尖瓣成形或置换的患者术后中远期效果相对较差。

英文摘要:

ABSTRACT Objective：To analyze the mid-long-term efficacy and its influencing factors of modified maze procedure using bipolar radiofrequency ablation during concomitant cardiac valve replacement surgery in the treatment of atrial fibrillation. Methods：72 patients who underwent modified maze procedure using bipolar radiofrequency ablation concomitant with cardiac valve replacement surgery in our department formJuly 2007 to December 2010 were selected. After three to six years' follow-up, their postoperative electrocardiograms with 12-lead or the dynamic electrocardiograms and echocardiography data were collected. We also recorded how they took the medicine after surgery and related complications and the recovery of their cardiac function and life quality and some useful information. Patients were divided into sinus group and non-sinus group according to the results of their ECG or 24-hour Holter. We used statistical methods to analyze the difference of the related factors before operation between the two groups. Results：At the end of follow-up, 63.2 % patients maintained sinus rhythm among 68 patients accomplished effective follow-up. In univariate analysis, preoperative AF duration, preoperative left ventricular ejection fraction and whether combined with tricuspid valve replacement or plasty are risk factors affected the results of operation. In multivariate analysis, preoperative AF duration and whether combined with tricuspid valve replacement or plasty are risk factors affected the results of operation. Conclusion：Modified maze procedure using bipolar radiofrequency ablation during concomitant cardiac valve replacement surgery had good mid-long-term efficacy in the treatment of atrial fibrillation, which caused only a few postoperative complications and could effectively prevent the thromboembolism. The mid-long-termefficacy of patients with long preoperative AF duration or concomitant with tricuspid valve replacement or plasty were relatively poorer.

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