Hanke T, Sievers H-H
Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
Herz. 2011 Dec;36(8):688-95. doi: 10.1007/s00059-011-3533-5.
Atrial fibrillation represents the most common atrial arrhythmia seen in clinical practice. The surgical treatment of atrial fibrillation is recommended in symptomatic patients as well as in asymptomatic patients at low postoperative risk. As a "stand alone" procedure, surgical ablation therapy is indicated after failed catheter ablation therapy, which occurs increasingly due to the high number of catheter-based ablation techniques. In order to gain acceptance among patients as well as referring cardiologists, the surgical ablation procedure ought to be performed in a minimally invasive fashion and with a very high success rate. When applied in an interdisciplinary approach by cardiologists/electrophysiologists and cardiothoracic surgeons, both ablative techniques have the potential to treat atrial fibrillation effectively and in the long-term. In order to document the true heart rhythm after ablation therapy, intermittent "snapshot" ECG documentation ought to be avoided. Small leadless devices that can be implanted subcutaneously enable full heart rhythm disclosure with documentation of atrial arrhythmias. The modern technique of implantable loop recorders permits individualized treatment for each patient.
心房颤动是临床实践中最常见的房性心律失常。对于有症状的患者以及术后风险较低的无症状患者,建议进行心房颤动的外科治疗。作为一种“独立”手术,在导管消融治疗失败后可采用外科消融治疗,由于基于导管的消融技术数量众多,这种情况越来越常见。为了获得患者以及转诊心脏病专家的认可,外科消融手术应以微创方式进行且成功率要非常高。当心脏病专家/电生理学家和心胸外科医生采用跨学科方法应用这两种消融技术时,二者都有潜力有效且长期地治疗心房颤动。为了记录消融治疗后的真实心律,应避免间歇性的“快照”心电图记录。可皮下植入的小型无导线装置能够完整揭示心律并记录房性心律失常。植入式环路记录仪的现代技术允许对每位患者进行个体化治疗。