Kalil Renato A K, Lima Gustavo G, Leiria Tiago L L, Abrahão Rogério, Pires Leonardo M, Prates Paulo R, Nesralla Ivo A
Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
Ann Thorac Surg. 2002 Apr;73(4):1169-73. doi: 10.1016/s0003-4975(01)03596-2.
Chronic atrial fibrillation (AF) due to mitral valve disease has been successfully treated by surgery. We performed a study to evaluate the effectiveness of a surgical method of simple pulmonary vein isolation (PVI) without radiofrequency or cryoablation in the restoration of sinus rhythm in a group of patients.
Fifteen patients were operated on for mitral valve disease and chronic AF. The technique consists basically of a circumferential incision excluding the pulmonary vein ostia from the left atrium.
Sinus rhythm was achieved in 92.3% of the patients at 6-month follow-up. Echocardiograms 2 months after surgery showed a mean decrease of 1.1 cm in left atrial size. Effective atrial ejection was reestablished in all patients in whom sinus rhythm was achieved (mean LA ejection fraction 41% +/- 14%). Twenty-four hour Holter recordings did not show episodes of paroxysmal atrial fibrillation in any patients. Four patients had isolated episodes of ventricular ectopic beats. Stress electrocardiograms showed mean maximal ventricular response was 64% +/- 11% and 73% +/- 9% of predicted value at 2 and 6 months, respectively. All patients had improved NYHA functional class after surgery; 74% of patients were in NYHA functional class I at 6 months compared with 13.3% preoperatively.
Pulmonary vein isolation without the use of radiofrequency or cryoablation is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease. Based on simple surgical incisions, this technique is more advantageous than others requiring additional instrumentation.
二尖瓣疾病所致的慢性心房颤动（房颤）已通过手术成功治疗。我们开展了一项研究，以评估一种不使用射频或冷冻消融的简单肺静脉隔离（PVI）手术方法在一组患者恢复窦性心律方面的有效性。
15例因二尖瓣疾病和慢性房颤接受手术。该技术主要包括在左心房做一个环绕切口，将肺静脉开口排除在外。
6个月随访时，92.3%的患者恢复窦性心律。术后2个月的超声心动图显示左心房大小平均减小1.1 cm。所有恢复窦性心律的患者均重新建立了有效的心房射血（左心房平均射血分数41%±14%）。24小时动态心电图记录显示，所有患者均未出现阵发性房颤发作。4例患者有孤立性室性早搏发作。应激心电图显示，术后2个月和6个月时平均最大心室反应分别为预测值的64%±11%和73%±9%。所有患者术后纽约心脏协会（NYHA）心功能分级均有改善；6个月时74%的患者为NYHA心功能I级，而术前为13.3%。
不使用射频或冷冻消融的肺静脉隔离对二尖瓣疾病继发的慢性房颤患者恢复窦性心律有效。基于简单的手术切口，该技术比其他需要额外器械的技术更具优势。
