Manasse Eric, Gaita Fiorenzo, Ghiselli Simone, Barbone Alessandro, Garberoglio Lucia, Citterio Enrico, Ornaghi Diego, Gallotti Roberto
Department of Cardiac Surgery, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan, Italy.
Eur J Cardiothorac Surg. 2003 Nov;24(5):731-40. doi: 10.1016/s1010-7940(03)00496-2.
Endocardial ablation of the left atrial posterior wall has been used to treat atrial fibrillation. Aim of the study was to evaluate its efficacy looking for the ablation pattern allowing a fast execution with limited interference on atrial contractility. Moreover a statistical analysis to identify predictors of long-term sinus rhythm recovery has been provided.
From April 1998 to May 2002, 95 patients with permanent (mean duration 65 months) or persistent (33%) atrial fibrillation have undergone three different ablation patterns, only 1 patient being affected by lone atrial fibrillation. Mean antero-posterior left atrial diameter was 76.2 mm. The prospective study collected information regarding variables related to patients' demographics, disease's characteristics and type of surgical ablation employed. Dependent variables were presence of sinus rhythm either at discharge and at 6 months. A logistic regression analysis was used to estimate the association between the collected variables and sinus rhythm restoration.
In-hospital and late mortality rate were 3.2 and 6.3% respectively. At discharge 67 patients (72.8%) were in sinus rhythm while at a mean follow-up of 3 years, 81.4% of 86 surviving patients are in sinus rhythm. Major adverse events rate including cardiac reoperation, pace-maker implantation and cerebrovascular accident were 8.5, 6.3 and 4.2%, respectively. Pre-operative atrial fibrillation duration, left atrial dimension and type of mitral disease did not show any correlation with long term success while the lesion pattern and the rhythm at discharge were significant predictive factors. Survival is significantly higher in patients who converted to sinus rhythm at discharge (P=0.014) with respect to those who remained in atrial fibrillation.
Permanent and persistent atrial fibrillation associated to a major cardiac disease can be safely treated with a linear ablation of the left atrial posterior wall. Satisfactory results in terms of rhythm restoration may be achieved regardless of the duration of the arrhythmia and its effects on atrial diameter. Any effort should be prompted to discharge patients in sinus rhythm. Life expectancy is longer if sinus rhythm is restored.
左心房后壁心内膜消融术已用于治疗心房颤动。本研究的目的是评估其疗效，寻找能快速实施且对心房收缩性干扰有限的消融模式。此外，还进行了统计分析以确定长期窦性心律恢复的预测因素。
1998年4月至2002年5月，95例永久性（平均病程65个月）或持续性（33%）心房颤动患者接受了三种不同的消融模式，仅1例患者为孤立性心房颤动。左心房前后径平均为76.2mm。这项前瞻性研究收集了有关患者人口统计学、疾病特征和所采用手术消融类型的变量信息。因变量为出院时和6个月时的窦性心律情况。采用逻辑回归分析来估计所收集变量与窦性心律恢复之间的关联。
住院死亡率和晚期死亡率分别为3.2%和6.3%。出院时67例患者（72.8%）为窦性心律，在平均3年的随访中，86例存活患者中有81.4%为窦性心律。包括心脏再次手术、起搏器植入和脑血管意外在内的主要不良事件发生率分别为8.5%、6.3%和4.2%。术前心房颤动病程、左心房大小和二尖瓣疾病类型与长期成功率无相关性，而病变模式和出院时的心律是显著的预测因素。出院时转为窦性心律的患者生存率显著高于仍为心房颤动的患者（P=0.014）。
与重大心脏疾病相关的永久性和持续性心房颤动可通过左心房后壁线性消融术安全治疗。无论心律失常的持续时间及其对心房大小的影响如何，在心律恢复方面均可取得满意结果。应促使患者在出院时达到窦性心律。恢复窦性心律可延长预期寿命。
