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目的:探讨去自主神经化(ganglion plexus ablation，GPA)联合射频消融(radiofrequency ablation，RF)治疗瓣膜病合并长程持续性房颤(long-standing persistent atrial fibrillation，LSP-AF)的远期效果。方法:回顾性研究268例瓣膜病合并LSP-AF，在瓣膜手术同时行RF或RF＋GPA手术的患者。根据围手术期资料、心律状态、生存率和临床事件的数据，针对RF和RF＋GPA进行倾向评分，匹配筛选每组102例患者。结果:在不应用抗心律失常药物情况下，术后1年窦性心律维持率的独立预测因素包括：同时行GPA(n OR＝0.205，n P＝ 0.005)，较小的左心房大小(n OR＝1.091，n P＝0.000)；术后5年包括较短房颤史(n OR＝1.069，n P＝0.023)，较小的左心房大小(n OR＝1.090，n P＝0.000)；术后8年包括较短房颤史(n OR＝1.066，n P＝0.030)，较小的左心房大小(n OR＝1.086，n P＝0.000)。应用倾向评分匹配后，RF＋GPA组术后6个月内接受心脏电复律的患者显著低于RF组(2.0%对8.8%，n P＝0.030)。在不使用抗心律失常药物情况下，与RF组相比，RF＋GPA组的窦性心律维持率6个月时(91.3%对79.8%，n P＝0.026)和1年时(90.2%对78.5%，n P＝0.028)更高，但在5年时(64.8%对64.4%，n P＝0.956)和8年时(53.3%对50.6%，n P＝0.711)差异无统计学意义。如果加上使用抗心律失常药物患者，RF＋GPA组与RF组在6个月(92.4%对88.3%，n P＝0.345)和1年时(91.3%对86.0%，n P＝0.257)差异无统计学意义。RF＋GPA组与RF组相比，两者术后8年的生存率差异无统计学意义(91.75%对93.75%，n HR＝1.327，95%n CI：0.463～3.802，n P＝0.598)。n 结论:瓣膜病合并长程持续性房颤患者中，瓣膜手术同期行双极射频消融手术，加做去自主神经化有助于提高术后早期窦性心律维持率，减少抗心律失常药物和心脏电复律的使用。但是该效应将在1年后逐渐消失。“,”Objective:To evaluate the long-term results of combined ganglion plexus ablation(GPA) during radiofrequency ablation(RF) with long-standing persistent atrial fibrillation(LSP-AF).Methods:This retrospective study sample consisted of 268 patients with LSP-AF underwent valve operations concomitant RF maze Ⅳ procedure. Data were collected prospectively on perioperative outcomes, rhythm status, survival, and clinical events. Propensity score matching conducted by RF and RF+ GPA resulted in 102 patients per group.Results:Independent predictors for rhythm success at 1 year were combined GPA(n OR=0.205, n P=0.005), smaller left atrium size(n OR=1.091, n P=0.000); at 5-year and 8-year were a shorter history of AF(n OR=1.069, n P=0.023; n OR=1.066, n P=0.030), and smaller left atrium size(n OR=1.091, n P=0.000; n OR=1.086, n P=0.000). After matching, RF+ GPA group had significantly higher sinus rhythm(SR) without antiarrhythmic drugs(AADs) at 6 months(91.3% vs. 79.8%, n P=0.026), 1-year(90.2% vs. 78.5%, n P=0.028), but there were no difference between the two groups at 5-year(64.8% vs. 64.4%, n P=0.956), and 8-year(53.3% vs. 50.6%, n P=0.711). During the 6 postoperative months, fewer patients in the RF+ GPA group underwent follow-up cardioversions(2.0% vs. 8.8%, n P=0.030). Actuarial survival curves did not differ significantly between the 2 groups(n HR=1.327, 95%n CI 0.4633-3.802, n P=0.598).n Conclusion:The combination of GPA can be effective at the early postoperative stage for SR restoration in Maze Ⅳ procedures for the treatment of LSP-AF in heart valve surgeries, particularly for lower AADs use and lower cardioversions. However, this effect will gradually diminish after one year.