State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Eur J Cardiothorac Surg. 2012 Mar;41(3):556-60. doi: 10.1093/ejcts/ezr101. Epub 2011 Dec 9.
Whether patients with recent onset of paroxysmal atrial fibrillation (PAF) might benefit of epicardial atrial fibrillation (AF) ablation concomitant to coronary artery bypass graft (CABG) is not known. The aim of this prospective, randomized, single-centre pilot study is the comparison of patients with first diagnosed AF submitted to CABG and treated with and without epicardial pulmonary vein isolation (PVI).
Patients with first diagnosed PAF and indication for CABG were enrolled in this prospective randomized pilot study. The primary endpoint was AF-free survival (AF burden <0.5%) between the two groups at 18-month follow-up. The secondary endpoints were the percentage of AF burden defined through continuous monitoring using an implantable loop recorder, thromboembolic events and procedural complications. All patients were implanted with a subcutaneous cardiac monitor to track the cardiac rhythm and measure the AF burden.
This study enrolled 35 patients (mean age 59 ± 7 years, 74% males), followed up for 18 months after CABG. The patients were randomly allocated to two groups, CABG alone (n = 17) and CABG with concomitant PVI (n = 18). At 18-month follow-up after surgery, 16 (89%) patients in the CABG + PVI group were AF-free (i.e. AF% < 0.5%) vs 8 (47%) in the CABG only group (log-rank test, P = 0.007). At the end of follow-up, the mean AF burden in the CABG and the CABG + PVI group was 7.8 ± 5.1 and 1.6 ± 1.8%, respectively (P < 0.001). Two (18.2%) of the 11 patients with AF recurrences were completely asymptomatic.
Patients with recent-onset AF submitted to CABG may benefit of concomitant ablation of the arrhythmia for preventing recurrences.
对于新近发生阵发性心房颤动（PAF）的患者，是否可以通过心外膜心房颤动（AF）消融术联合冠状动脉旁路移植术（CABG）获益，目前尚不清楚。本前瞻性、随机、单中心试验研究的目的是比较初次诊断为 AF 且需要接受 CABG 治疗的患者，这些患者分为接受和不接受心外膜肺静脉隔离（PVI）治疗的两组。
本前瞻性随机试验研究纳入了初次诊断为 PAF 且需要接受 CABG 治疗的患者。主要终点是两组患者在 18 个月随访时的无 AF 生存（AF 负荷<0.5%）。次要终点是通过植入式环路记录器进行连续监测定义的 AF 负荷百分比、血栓栓塞事件和程序并发症。所有患者均植入皮下心脏监测器以跟踪心律并测量 AF 负荷。
本研究纳入了 35 名患者（平均年龄 59 ± 7 岁，74%为男性），在 CABG 后随访 18 个月。患者随机分为两组，单纯 CABG 组（n = 17）和 CABG 联合心外膜 PVI 组（n = 18）。在手术后 18 个月的随访中，CABG + PVI 组的 16 名（89%）患者无 AF（即 AF%<0.5%），而单纯 CABG 组的 8 名（47%）患者有 AF（log-rank 检验，P=0.007）。在随访结束时，CABG 组和 CABG + PVI 组的平均 AF 负荷分别为 7.8 ± 5.1%和 1.6 ± 1.8%（P<0.001）。11 名 AF 复发患者中有 2 名（18.2%）完全无症状。
新近发生 AF 的 CABG 患者可能受益于心外膜心律失常消融术以预防复发。
