Hornero Fernando, Rodriguez Ignacio, Estevez Vanesa, Gil Oscar, Canovas Sergio, Garcia Rafael, Leon Juan Martinez
Department of Cardiac Surgery of Consorcio Hospital General Universitario de Valencia, Valencia University, Valencia, Spain.
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1493-8. doi: 10.1016/j.jtcvs.2007.01.038.
Late recurrence of atrial fibrillation frequently occurs after atrial ablation. Risk stratification for success and recurrence of the antiarrhythmic surgical procedure has not yet been established. We studied postoperative epicardial unipolar auriculograms to distinguish between high- and low-risk patients with late recurrence of atrial fibrillation.
Epicardial atrial fibrillatory activity was registered in 70 patients with surgical ablation of permanent atrial fibrillation and postoperative recurrence through the temporary wires. The atrial activation pattern was characterized in 3 groups (type I, II, and III) using Wells's criteria. The groups were homogeneous in the main clinical preoperative and surgical variables.
Mean atrial frequency of postoperative atrial fibrillation recurrence showed differences between groups: 225 +/- 53 ms in type I, 177 +/- 21 ms in type II, and 150 +/- 19 ms in type III (P < .01). At the end of the study, sinus rhythm was achieved in 80% of the subjects with type I, 87.5% with type II, and 23.8% with type III (P < .001). During follow-up, late atrial fibrillation recurred in 21.7% of patients with type I, 17.4% with type II, and 64.2% with auriculogram type III. In multivariate regression analysis, the postoperative auriculogram type III was the only predictor of late atrial fibrillation recurrence (odds ratio 15.6; 95% confidence interval, 3.2-74.7; P < .001).
The unipolar epicardial auriculogram was able to characterize the complexity of the postoperative fibrillatory process and also to identify patients with a high risk of late recurrence. Auriculogram type III had a low success rate for the intraoperative ablation procedure. The lines of the ablation procedure facilitated organization of the auriculograms.
心房颤动的晚期复发在心房消融术后经常发生。抗心律失常手术的成功及复发的风险分层尚未确立。我们研究了术后的心外膜单极心房电图，以区分心房颤动晚期复发的高危和低危患者。
通过临时导线记录了70例接受永久性心房颤动手术消融且术后复发患者的心外膜心房颤动活动。采用韦尔斯标准将心房激动模式分为3组（I型、II型和III型）。这些组在主要的术前临床和手术变量方面具有同质性。
术后心房颤动复发的平均心房频率在各组之间存在差异：I型为225±53毫秒，II型为177±21毫秒，III型为150±19毫秒（P<.01）。在研究结束时，I型受试者中有80%恢复窦性心律，II型为87.5%，III型为23.8%（P<.001）。在随访期间，I型患者中有21.7%发生晚期心房颤动复发，II型为17.4%，III型心房电图患者为64.2%。在多变量回归分析中，术后心房电图III型是晚期心房颤动复发的唯一预测因素（优势比15.6；95%置信区间，3.2 - 74.7；P<.001）。
心外膜单极心房电图能够表征术后颤动过程的复杂性，还能识别晚期复发高危患者。心房电图III型在术中消融手术中的成功率较低。消融手术的线路有助于心房电图的整理。
