Heart Hospital Baylor Plano, Plano, Texas; Cardiopulmonary Research, Science, and Technology Institute (CRSTI), Dallas, Texas, USA.
Heart Rhythm. 2009 Dec;6(12 Suppl):S64-70. doi: 10.1016/j.hrthm.2009.09.011. Epub 2009 Sep 11.
Minimally invasive surgery consisting of bipolar radiofrequency pulmonary vein (PV) isolation and limited ganglionated plexus ablation is effective in eliminating atrial fibrillation (AF) in patients with paroxysmal AF but is less effective in those with persistent AF or long-standing persistent AF. The purpose of this study was examine the results of minimally invasive surgery incorporating an additional set of radiofrequency ablation lines replicating a left-sided Cox maze III procedure. Thirty patients with persistent AF (n = 10) or long-standing persistent AF (n = 20) underwent minimally invasive surgery with an extended lesion set and PV isolation for a minimum follow-up of 6 months. Linear lesions were created at the roof line, at the anterior line, and between the roof line and the left atrial appendage. All patients underwent limited ganglionated plexus ablation and left atrial appendage excision as well as PV isolation verification. Block across the roof and anterior lines was confirmed in 29 (96.6%) of the 30 patients. Follow-up included 2-week event monitoring with auto-trigger in 21 patients, pacemaker interrogation in 8, and ECG in 1 who was in AF and refused longer-term monitoring. No operative mortality or major morbidity occurred. At 6 months, 24 (80%) of the 30 patients were free of AF: 15 (75%) with long-standing persistent AF and 9 (90%) with persistent AF. Among the six failures, burden of AF was low: one had 1 episode >15 seconds, two had 4 episodes, one had 6 episodes, one had >50 episodes, and one had AF on ECG and refused further monitoring. Early results of minimally invasive surgery with a new extended linear lesion set suggest increased efficacy over PV isolation and limited ganglionated plexus ablation in patients with persistent AF or long-standing persistent AF.
微创手术包括双极射频肺静脉（PV）隔离和有限的神经节丛消融，在阵发性 AF 患者中消除房颤（AF）是有效的，但在持续性 AF 或持久性持续性 AF 患者中效果较差。本研究的目的是检查微创性手术的结果，该手术包括一组额外的射频消融线，复制左侧 Cox 迷宫 III 手术。30 例持续性 AF（n=10）或持久性持续性 AF（n=20）患者接受微创性手术，进行扩展病变组和 PV 隔离，随访时间至少为 6 个月。在房顶线、前壁线和房顶线与左心房附件之间创建线性病变。所有患者均进行有限的神经节丛消融和左心房附件切除以及 PV 隔离验证。在 30 例患者中的 29 例（96.6%）确认了房顶线和前壁线的阻塞。随访包括 21 例患者进行 2 周事件监测，自动触发，8 例患者进行起搏器询问，1 例患者进行心电图检查，该患者处于 AF 状态并拒绝进行更长期监测。无手术死亡或主要并发症发生。6 个月时，30 例患者中有 24 例（80%）无 AF：15 例（75%）为持久性持续性 AF，9 例（90%）为持续性 AF。在 6 例失败中，AF 负担较低：1 例有 1 次>15 秒，2 例有 4 次，1 例有 6 次，1 例有>50 次，1 例有 ECG 上的 AF 并拒绝进一步监测。新的扩展线性病变组微创手术的早期结果表明，在持续性 AF 或持久性持续性 AF 患者中，与 PV 隔离和有限的神经节丛消融相比，疗效提高。
