Maly Jiri, Kautzner Josef, Krausova Renata, Rokosny Slavomir, Netuka Ivan, Szarszoi Ondrej, Skalsky Ivo, Pirk Jan
Departments of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Heart Surg Forum. 2008;11(2):E110-6. doi: 10.1532/HSF98.20071165.
Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent atrial fibrillation (AF) as a concomitant procedure. The aim of this study was to review the long-term outcomes of radiofrequency linear ablation for the treatment of AF limited to the left atrium in 3 groups of patients undergoing cardiac surgery.
The study population consisted of 357 consecutive patients, who were divided into 3 groups on the basis of the underlying disease: group I, 126 patients with nonischemic mitral valve disease; group II, 164 patients with coronary artery disease and aortic and/or ischemic mitral valve disease or who underwent other concomitant procedures; and group III, 67 patients with coronary artery disease only.
Follow-up times were between 6 and 48 months (mean, 28.3 + 9.4 months). The 30-day hospital mortality rate was 2.80% (10 patients). Total mortality during the follow-up period reached 4.48% (16 patients). At discharge, 66% of group I patients, 64% of group II patients, and 69% of group in patients were in sinus rhythm. After 24 months, 60% of group I patients, 75% of group II patients, and 67% of group III patients were in sinus rhythm. A subgroup analysis of the patients with permanent AF showed that only 54% of these patients in group I, 52% in group II, and 67% in group III had a restored sinus rhythm at 24 months. Subgroup analysis also revealed that only 6 (27%) of 22 patients with a left atrium diameter >60 mm maintained a sinus rhythm during long-term follow-up. Biatrial contraction was restored in 75% of the patients with a stable sinus rhythm after 6 months of follow-up. Seven patients (2%) with symptomatic postoperative recurrent atrial arrhythmias underwent subsequent catheter ablation.
Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent AF as a concomitant procedure. Our results demonstrate the feasibility of this procedure for paroxysmal and persistent AF, with minimal risks to the patient. For permanent AF, further investigation and extensive intervention are essential.
左心房外科射频消融术是一种适用于治疗阵发性或永久性心房颤动（AF）的方法，作为心脏手术的一个伴随操作，其技术要求较低。本研究的目的是回顾三组接受心脏手术患者中，仅限于左心房的射频线性消融治疗房颤的长期结果。
研究人群包括357例连续患者，根据基础疾病分为3组：第一组，126例非缺血性二尖瓣疾病患者；第二组，164例患有冠状动脉疾病、主动脉和/或缺血性二尖瓣疾病或接受其他伴随手术的患者；第三组,67例仅患有冠状动脉疾病的患者。
随访时间为6至48个月（平均28.3±9.4个月）。30天住院死亡率为2.80%（10例患者）。随访期间总死亡率达到4.48%（16例患者）。出院时，第一组66%的患者、第二组64%的患者和第三组69%的患者处于窦性心律。24个月后，第一组60%的患者、第二组75%的患者和第三组67%的患者处于窦性心律状态。对永久性房颤患者的亚组分析显示，24个月时，这些患者中第一组只有54%、第二组52%、第三组67%恢复了窦性心律。亚组分析还显示，22例左心房直径>60mm的患者中，只有6例（27%）在长期随访中维持窦性心律。随访6个月后，75%窦性心律稳定的患者恢复了双心房收缩功能。7例（2%）有症状的术后复发性房性心律失常患者随后接受了导管消融治疗。
左心房外科射频消融术是一种适用于治疗阵发性或永久性房颤的方法，作为心脏手术的一个伴随操作，其技术要求较低。我们的结果证明了该手术对于阵发性和持续性房颤的可行性，对患者的风险极小。对于永久性房颤，进一步的研究和广泛的干预至关重要。
