Atrial fibrillation Center, Anzhen Hospital, Beijing, China.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):326-32. doi: 10.1016/j.jtcvs.2009.04.029. Epub 2009 Jul 25.
We sought to evaluate the feasibility and efficacy of a new type of video-assisted minimally invasive surgery for patients with atrial fibrillation.
Between December 2006 and February 2008, 81 patients with lone atrial fibrillation (49 with paroxysmal, 17 with persistent, and 15 with long-standing persistent atrial fibrillation) underwent this therapy with a bipolar radiofrequency ablation system. The main surgical procedures included bilateral pulmonary vein antrum isolation, obliteration of the left atrial appendage, division of the ligament of Marshall, and intraoperative electrophysiologic testing.
The mean operation duration was 2.5 hours. One (1.2%) case was confirmed of left atrial appendage thrombus during the procedure. One (1.2%) patient was converted to sternotomy during the operation. Reintubation occurred in 1 (1.2%) patient, and acute heart failure occurred in 1 (1.2%) patient. One (1.2%) patient died of cerebral infarction 1 month after the operation. Follow-up was done between 3 and 19 months (mean, 12.7 +/- 3.9 months) after the operation. At discharge, 72.5% (58/81) of all patients were in sinus rhythm (paroxysmal atrial fibrillation, 83.7%; persistent atrial fibrillation, 64.7%; and long-standing persistent atrial fibrillation, 40.0%). At 3 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 82.4%; and long-standing persistent atrial fibrillation, 46.2%). At 6 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 70.6%; and long-standing persistent atrial fibrillation, 61.5%). At 12 months, overall 79.6% (39/49) were in sinus rhythm (paroxysmal atrial fibrillation, 80.0%; persistent atrial fibrillation, 75.0%; and long-standing persistent atrial fibrillation, 66.7%). At 18 months, 88.9% (8/9) of the paroxysmal group were in sinus rhythm.
This minimally invasive technique proves to be safe and less traumatic and presents optimistic early outcomes for patients with paroxysmal and persistent atrial fibrillation. It might find wider application if more ablation lesions could be enrolled for long-standing persistent atrial fibrillation.
我们旨在评估一种新型的视频辅助微创外科手术治疗心房颤动患者的可行性和疗效。
2006 年 12 月至 2008 年 2 月,81 例孤立性心房颤动患者(阵发性 49 例,持续性 17 例,持久性 15 例)接受了这种治疗,使用双极射频消融系统。主要手术包括双侧肺静脉窦隔离、左心耳闭塞、Marshall 韧带切开术和术中电生理检查。
手术平均持续时间为 2.5 小时。1 例(1.2%)术中证实左心耳血栓形成。1 例(1.2%)患者术中改行胸骨切开术。1 例(1.2%)患者需要重新插管,1 例(1.2%)患者发生急性心力衰竭。1 例(1.2%)患者术后 1 个月因脑梗死死亡。术后 3 至 19 个月(平均 12.7±3.9 个月)进行随访。出院时,所有患者中 72.5%(58/81)窦性心律(阵发性心房颤动 83.7%;持续性心房颤动 64.7%;持久性心房颤动 40.0%)。3 个月时,总窦性心律 78.5%(62/79)(阵发性心房颤动 85.7%;持续性心房颤动 82.4%;持久性心房颤动 46.2%)。6 个月时,总窦性心律 78.5%(62/79)(阵发性心房颤动 85.7%;持续性心房颤动 70.6%;持久性心房颤动 61.5%)。12 个月时,总窦性心律 79.6%(39/49)(阵发性心房颤动 80.0%;持续性心房颤动 75.0%;持久性心房颤动 66.7%)。18 个月时,9 例阵发性心房颤动患者中有 8 例窦性心律。
这种微创技术安全、创伤小,对阵发性和持续性心房颤动患者的早期结果乐观。如果能增加持久性心房颤动的消融病灶,可能会有更广泛的应用。