Sirak John, Jones Danielle, Sun Benjamin, Sai-Sudhakar Chittoor, Crestanello Juan, Firstenberg Michael
Ohio State University Department of Surgery, Division of Cardiothoracic Surgery, Columbus, Ohio, USA.
Ann Thorac Surg. 2008 Dec;86(6):1960-4. doi: 10.1016/j.athoracsur.2008.07.066.
Evolution of anti-arrhythmia surgery beyond the Cox maze III has been hampered by the difficulty in implementing a complete lesion set in a truly minimally invasive approach. In this study, we introduce a true port-access procedure that addresses both autonomic and anatomic sources of atrial fibrillation, with real-time verification of all technical endpoints.
A total of 32 patients with persistent or longstanding persistent atrial fibrillation underwent the totally thoracoscopic anti-arrhythmia procedure incorporating pulmonary vein isolation, mapping of epicardial autonomics, extended linear ablations across critical segments of atrial substrate, and ligation of the left atrial appendage. All aspects of the procedure were confirmed with intraoperative electrophysiologic testing.
With 1 week of continuous rhythm surveillance at 3, 6, and 13 months postoperatively in all patients, 21 of 24 patients with 6-month follow-up are in sinus rhythm with no anti-arrhythmia medications.
An anti-arrhythmia operation that is highly effective in patients with advanced forms of atrial fibrillation can be safely performed through a totally port-access approach.
由于难以采用真正的微创方法实现完整的损伤集合，抗心律失常手术在Cox迷宫III之外的发展受到了阻碍。在本研究中，我们介绍了一种真正的端口入路手术，该手术解决了心房颤动的自主神经和解剖学来源问题，并对所有技术终点进行实时验证。
共有32例持续性或长期持续性心房颤动患者接受了全胸腔镜抗心律失常手术，该手术包括肺静脉隔离、心外膜自主神经标测、跨越心房基质关键节段的扩展线性消融以及左心耳结扎。手术的所有方面均通过术中电生理测试得到证实。
所有患者在术后3、6和13个月进行了为期1周的连续心律监测，在24例接受6个月随访的患者中，有21例处于窦性心律，未使用抗心律失常药物。
对于晚期心房颤动患者非常有效的抗心律失常手术可以通过完全端口入路方法安全地进行。
