Department of Cardiothoracic Surgery and Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Europace. 2013 Feb;15(2):170-82. doi: 10.1093/europace/eus216. Epub 2012 Jul 10.
Despite its proven efficacy, the Cox-Maze III procedure did not gain widespread acceptance for the treatment of stand-alone atrial fibrillation (SA-AF) because of its complexity and technical difficulty. Surgical ablation for SA-AF can now be successfully performed utilizing minimally invasive surgery (MIS). This study provides an overview of state-of-the-art MIS for the treatment of SA-AF.
Studies selected for this review were identified on PUBMED and exclusion and inclusion criteria were applied to select the publication to be screened. Twenty-eight studies were included; 27 (96.4%) were observational in nature whereas 1 was prospective non-randomized. The total number of patients was 1051 (range 14-114). Mean age ranged from 45.3 to 67.1 years. Suboptimal results were obtained when employing microwave and high focused ultrasound energies. In contrast, MIS ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed as energy source, with antiarrhythmic drug-free success rate comparable to percutaneous catheter ablation (PCA). The success rate in paroxysmal was even higher than in PCA. In contrast, ganglionated plexi ablation and left atrial appendage removal seem not to influence the recurrence of AF and the occurrence of postoperative thromboembolic events.
Minimally invasive surgery ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed. Nevertheless, the relatively high complication rate reported suggest that such techniques require further refinement. Finally, the preliminary results of the hybrid approach are promising but they need to be confirmed.
尽管 Cox-Maze III 手术已被证实有效，但由于其复杂性和技术难度，该手术并未广泛用于治疗孤立性心房颤动（SA-AF）。现在，利用微创手术（MIS）可以成功地对 SA-AF 进行外科消融。本研究提供了 SA-AF 治疗领域的微创治疗最新技术概述。
在 PUBMED 上检索到用于本综述的研究，并应用排除和纳入标准来筛选要筛选的出版物。共纳入 28 项研究；其中 27 项（96.4%）为观察性研究，1 项为前瞻性非随机研究。总共有 1051 例患者（范围 14-114 例）。平均年龄从 45.3 岁到 67.1 岁不等。使用微波和高聚焦超声能量时，效果不理想。相比之下，当使用双极射频作为能源时，MIS 消融 SA-AF 可获得令人满意的 1 年结果，抗心律失常药物无成功率与经皮导管消融（PCA）相当。阵发性的成功率甚至高于 PCA。相比之下，神经节丛消融和左心耳切除似乎不会影响 AF 的复发和术后血栓栓塞事件的发生。
当使用双极射频时，微创外科消融 SA-AF 可获得令人满意的 1 年结果。然而，报告的相对较高的并发症发生率表明，这些技术需要进一步改进。最后，混合方法的初步结果很有希望，但需要进一步证实。
