Starck Christoph T, Steffel Jan, Emmert Maximilian Y, Plass Andre, Mahapatra Srijoy, Falk Volkmar, Salzberg Sacha P
Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):416-8. doi: 10.1093/icvts/ivs136. Epub 2012 May 30.
The exclusion of the left atrial appendage (LAA) has been used to reduce the risk of stroke associated with atrial fibrillation (AF). While LAA exclusion has been associated with a reduced risk of stroke, the effect on the electrical activity of the LAA (a potential source of AF) remains unknown. As such, we sought to demonstrate whether surgical epicardial clip occlusion leads to the electrical isolation of the LAA.
From December 2010 until August 2011, 10 patients with paroxysmal AF underwent off-pump coronary artery bypass surgery with bilateral pulmonary vein isolation and an LAA clip occlusion with a new epicardial clip. Before and after the clip was placed, pacing manoeuvres were performed to assess the electrical exit and entry blocks from the LAA.
All clips were applied successfully. The mean procedure time for the clip application was 4 ± 1 min. No complications occurred related to clip application. Prior to the pericardial closure, 18 ± 3 min after the clip placement, the LAA stimulation and pacing manoeuvres demonstrated complete electrical isolation of the LAA in all cases.
Epicardial LAA clip occlusion leads to the acute electrical isolation of the LAA and may not only provide stroke prevention but also reduce the recurrence of AF.
左心耳（LAA）封堵术已被用于降低心房颤动（AF）相关的中风风险。虽然LAA封堵与中风风险降低相关，但对LAA电活动（AF的一个潜在来源）的影响仍不清楚。因此，我们试图证明外科心外膜夹闭术是否会导致LAA电隔离。
从2010年12月至2011年8月，10例阵发性AF患者接受了非体外循环冠状动脉搭桥手术，同时进行双侧肺静脉隔离和使用新型心外膜夹进行LAA夹闭术。在放置夹子前后，进行起搏操作以评估LAA的电出口和入口阻滞。
所有夹子均成功应用。夹子应用的平均操作时间为4±1分钟。未发生与夹子应用相关的并发症。在放置夹子后18±3分钟，心包关闭前，LAA刺激和起搏操作在所有病例中均显示LAA完全电隔离。
心外膜LAA夹闭术可导致LAA急性电隔离，不仅可预防中风，还可能减少AF复发。
