Grubitzsch Herko, Grabow Christian, Orawa Helmut, Konertz Wolfgang
Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
Eur J Cardiothorac Surg. 2008 Jul;34(1):67-72. doi: 10.1016/j.ejcts.2008.03.054. Epub 2008 May 23.
Treatment of atrial fibrillation, a risk factor for morbidity and mortality, by left atrial ablation is a less complex procedure which is increasingly performed in conjunction with surgery for various heart diseases. Although restoration of sinus rhythm is effective initially, atrial fibrillation may recur. We investigated factors predicting the time until its recurrence.
Between January 2003 and December 2005, 162 consecutive patients (52.5% male, age 69+/-8.7 years) with permanent atrial fibrillation underwent concomitant left atrial ablation and isolated or combined mitral valve surgery (42.6%), isolated or combined aortic valve surgery (32.1%), and isolated or combined coronary artery bypass grafting (24.1%). Ablation was performed by microwave (n=93, 57.4%) or radiofrequency (n=69, 42.6%) technology. Follow-up was after 3, 6, 12 months and yearly thereafter. Predictive values of variables for postoperative atrial fibrillation were examined using techniques of univariate and multivariate survival analysis (proportional hazards regression).
Eight patients died perioperatively and 13 during follow-up (not ablation related). Two patients were lost to follow-up. At last follow-up (19+/-11.3 months), 86 patients (62%) were in stable sinus rhythm, 73 (52%) without antiarrhythmic drugs, and 43 (31%) were in atrial fibrillation. Predictors for the time until recurrence of atrial fibrillation in a multivariate model were preoperative atrial fibrillation duration (hazard ratio 1.005, 95% confidence interval 1.003-1.007, p<0.001) and left atrial diameter (hazard ratio 1.056, 95% confidence interval 1.020-1.093, p=0.002). Overall, sinus rhythm conversion rate was 75% when preoperative atrial fibrillation duration was less than 2 years, but 42% in longer lasting atrial fibrillation with left atrial dilatation (>50mm). Age, gender, primary heart disease, history of thromboembolism or cardioversion, presence of concomitant diseases, EuroScore, left ventricular size and function, aortic cross-clamp time, ablation technology, and treatment with antiarrhythmic drugs did not predict rhythm outcome.
Preoperative atrial fibrillation duration and left atrial diameter predict the time until atrial fibrillation recurrence after concomitant left atrial ablation, whereas age, type of primary cardiac surgery, ablation technology and antiarrhythmic therapy do not.
心房颤动是发病和死亡的危险因素，通过左心房消融术治疗是一种不太复杂的手术，越来越多地与各种心脏病的手术联合进行。虽然最初恢复窦性心律是有效的，但心房颤动可能会复发。我们研究了预测其复发时间的因素。
2003年1月至2005年12月期间，162例持续性心房颤动患者（男性占52.5%，年龄69±8.7岁）接受了左心房消融术并同期进行了单纯或联合二尖瓣手术（42.6%）、单纯或联合主动脉瓣手术（32.1%）以及单纯或联合冠状动脉搭桥术（24.1%）。消融采用微波技术（n = 93，57.4%）或射频技术（n = 69，42.6%）。术后3个月、6个月、12个月进行随访，此后每年随访一次。采用单因素和多因素生存分析（比例风险回归）技术检验变量对术后心房颤动的预测价值。
8例患者围手术期死亡，13例在随访期间死亡（与消融无关）。2例患者失访。在最后一次随访时（19±11.3个月），86例患者（62%）处于稳定的窦性心律，73例（52%）未使用抗心律失常药物，43例（31%）仍处于心房颤动状态。多因素模型中，心房颤动复发时间的预测因素为术前心房颤动持续时间（风险比1.005，95%置信区间1.003 - 1.007，p < 0.001）和左心房直径（风险比1.056，95%置信区间1.020 - 1.093，p = 0.002）。总体而言，术前心房颤动持续时间小于2年时，窦性心律转复率为75%，但在持续时间较长且左心房扩张（>50mm）的心房颤动中，转复率为42%。年龄、性别、原发性心脏病、血栓栓塞或心脏转复病史、合并疾病的存在、欧洲心脏手术风险评估系统（EuroScore）、左心室大小和功能、主动脉阻断时间、消融技术以及抗心律失常药物治疗均不能预测心律转归。
术前心房颤动持续时间和左心房直径可预测左心房消融术后心房颤动复发的时间，而年龄、原发性心脏手术类型、消融技术和抗心律失常治疗则不能。
