Jansens Jean Luc, Ducart Anne, Preumont Nicolas, Jottrand Maurice, Stefanidis Constantin, Stoupel Eric, de Cannière Didier
Department of Cardiac Surgery, Erasme University Hospital, Brussels, Belgium.
Heart Surg Forum. 2004;7(6):E595-8. doi: 10.1532/HSF98.20041107.
Pulmonary vein isolation (PVI) has been shown to be effective treatment of patients with symptomatic paroxysmal atrial fibrillation (PAF). The percutaneous approach is currently the technique of choice. Unfortunately, this procedure has limitations and complications that lead to fluctuating success rates. We explored an alternative technique of robotic-enhanced, closed-chest PVI with an endoscopic microwave-based catheter.
Seven symptomatic PAF patients were included in the study. The pulmonary veins were isolated through right (only) robotic-enhanced thoracoscopy on the beating heart.
Six patients underwent successful endoscopic PVI. In 1 patient the operation was converted into small right thoracotomy. Operative assessment of the ablation line showed a successful electric block in every patient. Three months after the procedure, the first 5 patients were in permanent sinus rhythm. The 2 other patients had AF but had less frequent and less symptomatic episodes compared with the preoperative situation.
On the basis of this preliminary experience, we believe that in the near future endoscopic right-chest robotic-enhanced PVI on the beating heart may become a valid option in the treatment of symptomatic PAF patients. This procedure allows for more-reproducible ablation lines and may avoid many of the pitfalls and drawbacks of the percutaneous approach. Therefore this technique deserves larger prospective evaluation in the treatment of AF.
肺静脉隔离术（PVI）已被证明是治疗有症状阵发性心房颤动（PAF）患者的有效方法。目前经皮途径是首选技术。不幸的是，该手术存在局限性和并发症，导致成功率波动。我们探索了一种基于内镜微波导管的机器人辅助闭式胸腔PVI替代技术。
7例有症状的PAF患者纳入研究。通过在跳动心脏上仅经右侧机器人辅助胸腔镜隔离肺静脉。
6例患者成功进行了内镜下PVI。1例患者手术转为小切口右胸开胸手术。消融线的手术评估显示每位患者均成功实现电隔离。术后3个月，前5例患者维持窦性心律。另外2例患者仍有房颤，但与术前相比发作频率降低且症状减轻。
基于这一初步经验，我们认为在不久的将来，跳动心脏上的内镜下右胸机器人辅助PVI可能成为治疗有症状PAF患者的有效选择。该手术可实现更可重复的消融线，且可能避免经皮途径的许多陷阱和缺点。因此，该技术在房颤治疗中值得进行更大规模的前瞻性评估。
