Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
Eur J Cardiothorac Surg. 2012 Jan;41(1):113-8. doi: 10.1016/j.ejcts.2011.05.025.
Atrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia. Anti-arrhythmic drugs may be used to suppress ectopic foci and interrupt reentry circuits, but are often insufficient to treat recurrent AF and have a number of adverse effects. Alternative therapies, such as catheter and surgical ablation, have been explored. This investigation examines the importance of assessing exit block when performing surgical ablation during beating-heart treatment of AF.
This was an evaluation of pooled data from multicenter prospective results obtained in AF patients who received ablation with a new, irrigated, vacuum-integrated device that creates linear lesions during beating-heart/open-chest or minimally invasive, port-access procedures. Electrocardiogram or Holter data were collected intra-operatively and at 1, 3, 6, and 12 months. Outcomes were also evaluated for patients who were or 'were not' tested for exit block following the ablation procedure.
A total of 93 patients were treated (61 open-chest surgeries, 32 port-access procedures). There were no device-related complications and no operative mortality. At 341 days' average follow-up, 71/86 (83%) patients were free from AF, 66/86 (77%) were in sinus rhythm, and 60/86 (70%) were free from AF and off Class I and III anti-arrhythmic drugs (AADs). At 12 months, 23/23 (100%) patients with exit block confirmed were AF free compared with 13/21 (62%) patients with exit block not tested (p≤0.01, Fisher's exact test); 20/23 (87%) were in sinus rhythm compared with 12/21 (57%) patients with exit block not tested (p≤0.05, Fisher's exact test); and 20/23 (87%) were AF free without Class I and III AADs compared with 10/21 (48%) patients with exit block not tested (p≤0.01, Fisher's exact test). Both open-chest and port-access procedures yielded decreases in left-atrial size from baseline to 6 months' follow-up. Patients undergoing port-access procedures also observed an increase in left-ventricular ejection fraction, which was also significant at 6 months.
Patients in whom exit block was confirmed following an ablation procedure were more likely to have successful clinical outcomes. Since testing for exit block must be performed on a beating heart, total epicardial beating-heart ablation may provide an important treatment for AF, providing intra-operative feedback indicative of long-term outcomes.
心房颤动（AF）是最常见的心律失常。抗心律失常药物可用于抑制异位灶和中断折返环，但往往不足以治疗复发性 AF，并具有许多不良反应。已经探索了替代疗法，如导管和手术消融。本研究探讨了在心脏跳动时进行手术消融时评估出口阻滞对 AF 治疗的重要性。
这是对接受新型灌流、真空集成设备消融的 AF 患者多中心前瞻性结果的汇总数据进行的评估，该设备在心脏跳动/开胸或微创端口接入过程中创建线性病变。术中及术后 1、3、6 和 12 个月收集心电图或动态心电图数据。还评估了消融术后是否进行出口阻滞测试的患者的结果。
共治疗 93 例患者（61 例开胸手术，32 例端口接入手术）。无器械相关并发症和手术死亡率。平均随访 341 天，86/86（83%）例患者无 AF，66/86（77%）例患者窦性节律，60/86（70%）例患者无 AF 且无 I 类和 III 类抗心律失常药物（AAD）。12 个月时，23/23（100%）经证实存在出口阻滞的患者无 AF，而 21/21（62%）未进行出口阻滞测试的患者无 AF（p≤0.01，Fisher 确切检验）；23/23（87%）例患者窦性节律，而 21/21（57%）例未进行出口阻滞测试的患者窦性节律（p≤0.05，Fisher 确切检验）；23/23（87%）例患者无 AF 且无 I 类和 III 类 AAD，而 21/21（48%）例未进行出口阻滞测试的患者无 AF（p≤0.01，Fisher 确切检验）。开胸和端口接入手术均使左心房大小从基线减少到 6 个月的随访。行端口接入手术的患者还观察到左心室射血分数增加，6 个月时也有显著增加。
消融术后证实存在出口阻滞的患者更有可能获得成功的临床结果。由于必须在心脏跳动时进行出口阻滞测试，因此全外膜心脏跳动消融术可能为 AF 提供重要的治疗方法，并提供术中反馈，预示长期结果。
