Geidel Stephan, Lass Michael, Ostermeyer Jörg
Hanseatisches Herzzentrum, Abteilung für Herzchirurgie, Asklepios Klinik St. Georg, Hamburg, Germany.
Heart Surg Forum. 2008;11(3):E175-80. doi: 10.1532/HSF98.20081027.
This study analyzed 7 years of results for monopolar endocardial radiofrequency (RF) ablation of permanent atrial fibrillation (pAF) concomitant to mitral valve (MV) surgery.
Between 2001 and 2007, 152 patients who had experienced pAF for a median of 4.0 years (interquartile range, 1.5-8.0 years; range, 0.5-33 years) underwent monopolar endocardial RF ablation procedures (pulmonary vein isolation plus a connecting lesion) concomitant to MV surgery. All patients were reexamined to assess survival, conversion rate to stable sinus rhythm (SR), and New York Heart Association (NYHA) class at 8 +/- 1 days after surgery and follow-ups at 3 +/- 1 months and 41 +/- 24 months postoperatively. Data were analyzed exploratatively.
The survival rates at the 3 reexamination times were 97%, 95%, and 92%, respectively (6 cardiac and 6 noncardiac deaths), and the corresponding SR rates were 74%, 75%, and 73%. The NYHA class of the patients improved significantly after surgery (P = .006), particularly when a stable SR had been achieved (P = .039). Long-term pAF prior to surgery and a larger left atrium (LA) preoperatively were predictive of the return of postoperative AF (P = .0002, and P = .0003, respectively). Ninety-one percent of the patients with a preoperative pAF duration of <5 years and 88% of the patients with an LA size of <or=55 mm were in stable SR at the late follow-up. The cardiac rhythm at discharge and 3 months after surgery were predictive of a prognosis of long-term rhythm (P = .021, and P = .00002, respectively). Age, sex, and the underlying etiology of MV disease did not have a significant influence on postoperative cardiac rhythm.
This study demonstrated that a SR established after combined pAF ablation and MV surgery remains stable over time. Preoperative LA size and pAF duration are useful parameters for evaluating the success rate of pAF ablation concomitant to MV surgery.
本研究分析了7年间二尖瓣（MV）手术同期进行单极心内膜射频（RF）消融治疗永久性心房颤动（pAF）的结果。
2001年至2007年期间，152例pAF患者（中位病程4.0年，四分位间距1.5 - 8.0年；范围0.5 - 33年）在MV手术同期接受了单极心内膜RF消融术（肺静脉隔离加连接性病变）。所有患者在术后8±1天、术后3±1个月和41±24个月进行复查，以评估生存率、转为稳定窦性心律（SR）的转化率以及纽约心脏协会（NYHA）心功能分级。对数据进行探索性分析。
3次复查时的生存率分别为97%、95%和92%（6例心脏死亡和6例非心脏死亡），相应的SR率分别为74%、75%和73%。患者的NYHA心功能分级在术后显著改善（P = 0.006），尤其是在实现稳定SR时（P = 0.039）。术前长期pAF和术前左心房（LA）较大可预测术后房颤复发（分别为P = 0.0002和P = 0.0003）。术前pAF病程<5年的患者中91%以及LA大小≤55 mm的患者中88%在晚期随访时处于稳定SR。出院时及术后3个月的心律可预测长期心律预后（分别为P = 0.021和P = 0.00002）。年龄、性别和MV疾病的潜在病因对术后心律无显著影响。
本研究表明，pAF消融与MV手术联合治疗后建立的SR随时间推移保持稳定。术前LA大小和pAF病程是评估MV手术同期pAF消融成功率的有用参数。
