右侧峡部消融可减少慢性房颤手术后的室上性心律失常。

Right isthmus ablation reduces supraventricular arrhythmias after surgery for chronic atrial fibrillation.

作者信息

Onorati Francesco, Esposito Antonio, Messina Gaetana, di Virgilio Antonio, Renzulli Attilio

机构信息

Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Napoli, Italy.

出版信息

Ann Thorac Surg. 2008 Jan;85(1):39-48. doi: 10.1016/j.athoracsur.2007.07.056.

DOI:10.1016/j.athoracsur.2007.07.056

PMID:18154775

Abstract

BACKGROUND

Clinical, electrocardiographic, and echocardiographic results of atrial fibrillation (AF) ablation by left mini-Maze, with or without concomitant cavotricuspid isthmus ablation, during cardiac surgery were analyzed.

METHODS

Eighty-seven patients undergoing radiofrequency left mini-Maze without (group A) or with (group B) concomitant cavotricuspid isthmus ablation underwent serial electrocardiography and echocardiography to assess sinus rhythm recovery and atrioventricular remodelling. Recurrence of AF, incidence of atrial flutter, hospital readmission, and episodes of congestive heart failure were recorded. Predictors of AF recurrence were evaluated.

RESULTS

Follow-up of 33.4 +/- 11.2 months demonstrated 88.5% had sinus rhythm recovery, with normalized E/A velocity in 90.9%. Freedom from AF recurrence, congestive heart failure, and hospital readmission was 72.6% +/- 7.8%, 93.3% +/- 5.5%, and 79.9% +/- 8.2%, respectively, without differences between the two groups. Atrial flutter developed in group A more frequently during hospitalization (19.5% versus 2.2%; p = 0.009) and follow-up (12.2% versus 0%; p = 0.02); freedom from atrial flutter was thus lower (79.6% +/- 7.8% versus 100%; p = 0.024). Although no differences were recorded in postoperative and follow-up New York Heart Association (NYHA) functional class or in postoperative or follow-up echocardiographic indicators between the two groups, AF patients displayed a worse NYHA than did sinus rhythm patients (discharge p = 0.009; follow-up p = 0.0002). Accordingly, only sinus rhythm patients showed reverse remodelling of longitudinal (discharge p = 0.002; follow-up p = 0.0001) and transverse diameter (discharge p = 0.0001; follow-up p = 0.001), and of follow-up left ventricular diastolic diameter (p = 0.0001). Mitral valve disease and high postoperative and follow-up echocardiographic pulmonary pressures were independent predictors of AF recurrence. Left + right ablation was the only protective factor against AF recurrence.

CONCLUSIONS

Concomitant cavotricuspid isthmus ablation should be routinely considered in AF surgery, given the shorter hospitalization, low incidence of atrial flutter onset, and beneficial effect on AF recurrences.

摘要

背景

分析了在心脏手术期间，采用左迷你迷宫术进行房颤（AF）消融，无论是否同时进行三尖瓣峡部消融的临床、心电图及超声心动图结果。

方法

87例接受射频左迷你迷宫术的患者，其中未同时进行三尖瓣峡部消融的患者为A组，同时进行三尖瓣峡部消融的患者为B组，接受系列心电图及超声心动图检查，以评估窦性心律恢复情况及房室重构。记录房颤复发情况、房扑发生率、再次入院情况及充血性心力衰竭发作情况。评估房颤复发的预测因素。

结果

随访33.4±11.2个月显示，88.5%的患者恢复窦性心律，90.9%的患者E/A速度正常化。两组患者无房颤复发、无充血性心力衰竭及未再次入院的比例分别为72.6%±7.8%、93.3%±5.5%及79.9%±8.2%，两组间无差异。A组在住院期间（19.5%对2.2%；p=0.009）及随访期间（12.2%对0%；p=0.02）房扑发生率更高；因此，无房扑的比例更低（79.6%±7.8%对100%；p=0.024）。尽管两组患者术后及随访时纽约心脏协会（NYHA）心功能分级、术后及随访时超声心动图指标无差异，但房颤患者的NYHA分级比窦性心律患者更差（出院时p=0.009；随访时p=0.0002）。相应地，只有窦性心律患者的纵向（出院时p=0.002；随访时p=0.0001）和横向直径（出院时p=0.0001；随访时p=0.001）以及随访时左心室舒张直径出现逆向重构（p=0.0001）。二尖瓣疾病以及术后及随访时超声心动图显示的高肺压是房颤复发的独立预测因素。左右两侧消融是预防房颤复发的唯一保护因素。