Abo-Salem Elsayed, Paone Ralph F, Nugent Kenneth, Perez-Verdia Alejandro, Deshpande Alok, Amiri Hoda Mojazi
Department of Cardiovascular Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
J Card Surg. 2013 May;28(3):315-20. doi: 10.1111/jocs.12092. Epub 2013 Mar 11.
Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms have been complicated by lack of success or intolerance of medications. Experience with minimally invasive AF surgery is relatively new, and early results have been promising. However, the study populations and techniques were heterogeneous, and the follow-up periods were short in many series.
We present a single center experience through a retrospective review of medical records of patients who had minimally invasive AF surgery.
The surgical techniques addressed several possible mechanisms of AF and causes of recurrence, including pulmonary vein isolation, underlying substrates modification, ligament of Marshall interruption, ganglion plexus ablation, and left atrial appendage exclusion. Thirty-three cases were identified. The mean duration of follow-up was 23.2 months, and 58.6% were maintained in a sinus rhythm and were off antiarrhythmic drugs at the end of the follow-up period. Cases with persistent AF had a lower success rate.
Results with minimally invasive surgery are suboptimal at two years of follow-up, particularly for patients with persistent AF.
对于心房颤动（AF）且症状难治的患者，维持窦性心律的试验因药物治疗缺乏成效或患者不耐受而变得复杂。微创房颤手术的经验相对较新，早期结果很有前景。然而，研究人群和技术存在异质性，并且在许多系列研究中随访期较短。
我们通过回顾性分析接受微创房颤手术患者的病历，展示了单中心的经验。
手术技术针对房颤的几种可能机制和复发原因，包括肺静脉隔离、潜在基质改良、Marshall韧带离断、神经节丛消融和左心耳排除。共确定了33例病例。平均随访时间为23.2个月，58.6%的患者在随访期末维持窦性心律且停用了抗心律失常药物。持续性房颤患者的成功率较低。
微创外科手术在随访两年时效果欠佳，尤其是对于持续性房颤患者。
