Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany.
Ann Thorac Surg. 2012 Dec;94(6):1886-92. doi: 10.1016/j.athoracsur.2012.07.035. Epub 2012 Sep 7.
Percutaneous catheter ablation has been the preferred treatment strategy for many patients with symptomatic drug-refractory atrial fibrillation (AF). However, incomplete ablation lines and varying success rates remain a problem in certain subgroups. This article evaluates the feasibility and efficacy of endoscopically performed left atrial ablation in patients with lone AF.
Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 89 consecutive patients with lone AF. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and resection of the left atrial appendage (LAA). Preoperative, perioperative, and postoperative data were collected prospectively and included questionnaires and 24-hour Holter monitoring at 6 and 12 months and annually thereafter.
Mean follow-up was 12±6 months (range, 4-28 months). No patients were lost to follow-up. Mean duration of AF was 6.4±5.7 years, with 35% paroxysmal AF and 65% persistent or long-standing persistent AF. Mean operation time was 180±43 minutes. There were no deaths, no conversion to sternotomy, and no early or late stroke. Freedom from AF was 88%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF without antiarrhythmic drugs was 71%, 82%, and 90% at 6, 12, and 24 months, respectively.
Endoscopic radiofrequency ablation on the beating heart reveals high success rates with low procedure-related morbidity. For improvement of future treatment strategies, a randomized trial is advisable to compare this procedure with catheter ablation in certain patient subgroups.
对于许多有症状且药物难治的心房颤动（AF）患者，经皮导管消融已成为首选的治疗策略。然而，在某些亚组中，消融线不完全和成功率不同仍然是一个问题。本文评估了在孤立性 AF 患者中进行内镜下心房消融的可行性和疗效。
通过双侧内镜方法在心搏中对 89 例连续孤立性 AF 患者进行心外膜双极射频消融。这包括使用夹具隔离肺静脉；使用线性消融装置隔离左心房后壁，包括到主动脉非冠状窦的三角线；以及切除左心耳（LAA）。前瞻性收集术前、围手术期和术后数据，包括问卷调查和术后 6 个月和 12 个月及以后每年的 24 小时 Holter 监测。
平均随访时间为 12±6 个月（范围，4-28 个月）。无患者失访。平均 AF 持续时间为 6.4±5.7 年，其中 35%为阵发性 AF，65%为持续性或长程持续性 AF。平均手术时间为 180±43 分钟。无死亡、无改胸骨切开术、无早期或晚期卒中。术后 6、12 和 24 个月时 AF 无发作的比例分别为 88%、90%和 90%。术后 6、12 和 24 个月时无抗心律失常药物的 AF 无发作的比例分别为 71%、82%和 90%。
在跳动的心脏上进行内镜射频消融显示出高成功率和低与手术相关的发病率。为了改进未来的治疗策略，建议进行一项随机试验，比较该程序与导管消融在某些患者亚组中的疗效。
