在持续性心房的 mitra 手术中进行左心房射频移除:一项随机对照试验
George Doukas1, Nilesh J Samani, Christos Alexiou
1Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, England. doukas_george@hotmail.com
JAMA
|November 10, 2005
概括
在中枢手术期间左心房的射频切除 (RFA) 在12个月后在44.4%的患者中显著恢复了鼻节律. 这种程序改善了运动能力,是慢性心房动的安全,有效的选择.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 电子生理学 电子生理学
背景情况:
- 在米特拉手术期间慢性心房动 (AF) 管理仍然是一个临床挑战.
- 左心房射频除 (RFA) 越来越多地使用,但随机试验的强有力的证据是有限的.
研究的目的:
- 评估手术内左心房RFA在中心手术后恢复鼻节律方面的疗效.
- 评估RFA对长期运动能力和功能状态的影响.
主要方法:
- 一个随机的双盲试验,涉及97名因慢性AF接受米特拉手术的患者.
- 患者被分配到与左心房RFA (n=49) 或单独的心心膜手术 (对照组,n=48) 的两种心膜手术中.
- 主要终点是12个月后的鼻节律;次要终点包括运动能力,心房收缩率,心脏尺寸和B型尿素水平.
主要成果:
- 在12个月后,RFA组的44.4%恢复了鼻腔节律,而对照组的4.5%恢复了 (率比,9.8;P<.001).
- RFA组在穿步行距离 (+94m vs +48m; P=.003) 和降低B型尿酸水平 (-104 vs -51 fmol/mL; P=.03) 中显著改善.
- 术后并发症和死亡率在各组之间相似.
结论:
- 在米特拉手术期间的内科手术左心房RFA显著增强了手术后一年的鼻节律恢复.
- 这种手术可以提高运动能力,并且与单独的 mitra 门手术相比,具有可比的安全性.
- 在这种患者群体中,常规使用左心房RFA可能在临床上是合理的.
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