Wang Jian-gang, Meng Xu, Li Yan, Han Jie, Xu Chun-lei, Cui Yong-qiang, Dong Jian-zeng, Ma Chang-sheng
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2011 May;39(5):429-33.
To compare the efficacy of the video-assisted minimally invasive radiofrequency ablation in comparison with catheter ablation for the treatment of persistent atrial fibrillation (AF).
A total of 172 patients [116 male, mean age (56 ± 12) years] with persistent AF underwent ablation procedures during the last 4 years in our institute (83 patients underwent video-assisted minimally invasive radiofrequency ablation, group MIA and 89 patients underwent circumferential pulmonary vein linear ablation, group CA). Mean duration of preoperative AF was (72 ± 68) months. Patients were follow-uped for a period of 1 to 3.6 years [mean (2.2 ± 0.8) years].
There was no procedure related death. During follow-up, one patient died of encephalorrhagia in CA group, one patient died of sudden death in each group. At the end of the procedure, there were 67 sinus rhythm (39.0%), 4 pacing rhythm (2.3%), 29 atrial flutter or atrial tachycardia (16.9%) and 72 AF (41.9%). Before discharge, sinus rhythm was recorded in 53 patients (63.9%) of MIA group and in 78 patients (87.6%) of CA group; AF recorded in 24 patients (28.9%) of MIA group and in 4 patients (4.5%) of CA group (P < 0.01). At the latest follow-up, sinus rhythm was recorded in 65 patients (79.3%) of MIA group and in 54 patients (62.1%) of CA group; AF or atrial flutter was recorded in 14 patients (17.1%) of MIA group and in 24 patients (27.6%) of CA group (P = 0.028). The Kaplan-Meier survival analysis showed that the long-term efficacy of MIA is superior to CA in terms of incidence of free of AF, AF recurrence and antiarrhythmic drugs (P = 0.03, P = 0.028, P = 0.017, respectively).
The video-assisted minimally invasive ablation was safe and effective, and had an optimistic long-term success rate for patients with long-lasting persistent AF. Thus, a randomized study comparing the long-term efficacy between the two procedures for patients with long-lasting persistent AF is warranted.
比较电视辅助微创射频消融术与导管消融术治疗持续性心房颤动（房颤）的疗效。
在过去4年中，我院共有172例持续性房颤患者[男性116例，平均年龄（56±12）岁]接受了消融手术（83例患者接受电视辅助微创射频消融术，即MIA组；89例患者接受环肺静脉线性消融术，即CA组）。术前房颤的平均持续时间为（72±68）个月。患者随访1至3.6年[平均（2.2±0.8）年]。
无手术相关死亡。随访期间，CA组有1例患者死于脑出血，每组各有1例患者死于猝死。手术结束时，有67例窦性心律（39.0%）、4例起搏心律（2.3%）、29例心房扑动或房性心动过速（16.9%）以及72例房颤（41.9%）。出院前，MIA组有53例患者（63.9%）记录到窦性心律，CA组有78例患者（87.6%）记录到窦性心律；MIA组有24例患者（28.9%）记录到房颤，CA组有4例患者（4.5%）记录到房颤（P<0.01）。在最近一次随访时，MIA组有65例患者（79.3%）记录到窦性心律，CA组有54例患者（62.1%）记录到窦性心律；MIA组有14例患者（17.1%）记录到房颤或心房扑动，CA组有24例患者（27.6%）记录到房颤或心房扑动（P=0.028）。Kaplan-Meier生存分析显示，在无房颤发生率、房颤复发率及抗心律失常药物使用方面，MIA的长期疗效优于CA（分别为P=0.03、P=0.028、P=0.017）。
电视辅助微创消融术安全有效，对于长期持续性房颤患者具有乐观的长期成功率。因此，有必要进行一项随机研究，比较这两种手术对长期持续性房颤患者的长期疗效。
