目的:探讨TCR(低温等离子射频)序贯治疗在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床疗效。方法:我院2003年8月至2007年2月收治153例轻中度OSAHS患者,采用TCR序贯治疗,初次手术后追踪患者情况,必要时分阶段分部位反复消融,并在术后半年,1年进行PSG检查等,对其疗效、并发症进行分析。结果:153例患者半年有效率86.27%。1年有效率73.20 %,无严重并发症发生。结论:TCR序贯治疗疗效确切,组织反应轻,可作为治疗轻中度OSAHS的有效方案。
ObjectiveTo investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsClinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). ConclusionImprovement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
ObjectiveTo investigate heart rhythm outcomes of radiofrequency ablation (RFA)of atrial fibrillation (AF)during mitral valve replacement (MVR)for patients with rheumatic heart disease (RHD), and explore clinical results of radiofrequency catheter ablation (RFCA)for postoperative atrial tachycardia (AT). MethodsEleven RHD patients who developed AT after RFA of AF during MVR were enrolled in this study. There were 4 males and 7 females with their age of 49±8 years. Electroanatomic mapping of the left or right atrium was conducted with three-dimensional electroana-tomic mapping system during continuous AT. RFCA was performed at the key areas of AT. ResultsFor MVR, operation time was 149±18 minutes, postoperative hospital stay was 9.5±2.9 days, and length of ICU stay was 1.8±0.4 days. During electroanatomic mapping, 17 ATs were recorded in 11 patients. Six ATs (35%)of 5 patients originated from the right atrium and 11 ATs (65%)of 6 patients originated from the left atrium (LA). Among them, AT of 2 patients was related to the mitral valve ring. Immediate success of RFCA was obtained in 91% (10/11). After a mean follow-up of 17±4 months, 2 patients whose AT originated from LA had AT recurrence. ConclusionsMajority of postoperative ATs originate from LA, and majority of ATs are not mitral-dependent. RFCA is an effective and safe procedure for AT in patients after RFA of AF during MVR.
ObjectiveTo systematically evaluate the pharmacoeconomic value of radiofrequency ablation (RFA) versus amiodarone in the treatment of atrial fibrillation (AF), and to provide reference for treatment scheme selection, drug selection and the formulation of drug policy. MethodsWe searched databases including PubMed, The Cochrane Library, CNKI and CBM from 2000 to 2014 to collect pharmacoeconomic studies on RFA versus Amiodarone for treating AF. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. The cost-effectiveness of RFA and Amiodarone for AF was compared according to the cost, effectiveness, and incremental cost-effectiveness ratio (ICER). ResultsA total of three studies were included. The results of pharmacoeconomic evaluation showed that the ICERs for each study were $7 976 to $29 068, ￡7 763 to ￡27 745, and $59 194, respectively. According to country-specific willingness to pay thresholds, the ICER of each included study was acceptable. ConclusionCompared to Amiodarone, RFA is a cost-effective therapy for AF.
ObjectiveTo discuss the intraoperative anesthesia management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest. MethodsWe retrospectively analyzed the clinical data of 201 patients (106 males and 95 females aged 58.7±15.4 years) with AF underwent complete thoracoscopic surgical ablation via the left chest in Department of Cardiothoracic surgery, Xinhua Hospital From September 2010 through December 2013. ResultsAll the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. During the ablation procedure, the patients' blood pressure and arterial oxygen saturation (SpO2) reduced at different levels. The average minimum arterial blood pressure was 44-79 (62.4±8.4) mm Hg. The average minimum SpO2 was 83%-95% (88.8%±3.1%). After the ablation, the patients' respiratory function and hemodynamic gradually recovered. The average heart rate was 40-108 (70.0±16.6) bpm when sinus rhythm was restored. The maintenance of sinus rhythm rate was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. ConclusionComplete thoracoscopic surgical AF ablation via the left chest has some influence on patients' respiratory function and hemodynamic. Reasonable anesthetic management can ensure the minimally invasive ablation procedure safe and effective.
ObjectiveTo assess the effect of a novel modified epicardial radiofrequency (RF) ablation for preoperative atrial fibrillation (AF) combined with aortic valve disease. MethodsWe retrospectively analyzed the clinical data of 28 patients with AF and aortic valve disease underwent the novel modified epicardial RF ablation combined with aortic valve replacement (AVR) in our hospital between December 2009 and December 2014. There were 18 males and 10 females at age of 53-73 (64.9±4.8) years. The patients were performed epicardial atrial fibrillation RF ablation plus aortic valve replacement. ResultsThe modified epicardial RF ablation and AVR were performed successfully in all the patients. The maintenance of sinus rhythm was 96.4% (27/28) at discharge. There were no early death and permanent pacemaker implantation in perioperation. At a mean following-up of 29.2±17.7 months, 26 of 28 (92.9%) patients were in sinus rhythm. Following-up transthoracic echocardiography(TTE) at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. ConclusionThe novel modified epicardial RF ablation procedure is safe, feasible, and effective. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.
ObjectiveTo investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. MethodsClinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A (absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females) and Group B (mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females). Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and mitral A velocity, as well as clinical and follow-up data were recorded and compared. ResultsPreoperative clinical characters were not statistically different between two groups (P > 0.05). All the patients were followed up for 24.3±8.8 months (range, 12-26 months). Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B (20.0% vs. 2.7%, P < 0.05). LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF (P < 0.05), but there was no statistic difference between two groups (P > 0.05). ConclusionDamage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.