Weimar Timo, Hanke Thorsten, Doll Nicolas
Sana Herzchirurgie Stuttgart GmbH, Herdweg 2, Stuttgart, Germany.
Herzschrittmacherther Elektrophysiol. 2013 Mar;24(1):19-24. doi: 10.1007/s00399-013-0246-x. Epub 2013 Apr 18.
Catheter ablation has been the preferred choice of treatment for many patients with atrial fibrillation (AF) and advanced to a first line treatment option. However, incomplete ablation lines and varying long-term success rates remain a problem in certain subgroups, especially patients with persistent AF or large left atria. Alternative energy sources and advances in the device design have shifted the surgeons' focus on less invasive procedures. Minimally invasive performed endocardial ablation or even endoscopical ablation on the beating heart reveals success rates of 90 % freedom from atrial fibrillation at 2 years independent from the duration or type of AF. The randomized FAST-trial demonstrated superiority of endoscopic ablation compared to catheter ablation after 1 year. Given the multiple theories of the mechanism causing AF and the results that can be achieved by minimally invasive surgery, a thoroughly assessment of the individual patients is mandatory and surgery should be considered in all symptomatic patients who have failed catheter ablation or who are not good candidates for catheter ablation.
导管消融术一直是许多心房颤动（AF）患者的首选治疗方法，并已发展成为一线治疗选择。然而，在某些亚组中，尤其是持续性房颤或左心房较大的患者，消融线不完全和长期成功率各异仍然是一个问题。替代能源和设备设计的进步已将外科医生的注意力转移到侵入性较小的手术上。在跳动的心脏上进行的微创心内膜消融甚至内镜消融显示，2年时房颤无复发率为90%，与房颤的持续时间或类型无关。随机的FAST试验表明，1年后内镜消融术优于导管消融术。鉴于导致房颤的机制有多种理论，以及微创手术所能取得的结果，对个体患者进行全面评估是必不可少的，对于导管消融失败或不适合导管消融的所有有症状患者，都应考虑手术治疗。
