Zembala Michael O, Suwalski Piotr
Department of Cardiothoracic Surgery and Transplantology, Silesian Center for Heart Diseases Zabrze, Poland;
J Thorac Dis. 2013 Nov;5 Suppl 6(Suppl 6):S704-12. doi: 10.3978/j.issn.2072-1439.2013.10.17.
Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage-a method of choice in one of the most important clinical trials on AF-The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of the two worlds. One goal remains: to help those in urgent need for everlasting relief.
心房颤动（AF）仍然是最常见的心律失常，影响着全球近2%的普通人群。微创外科消融术仍然是现代心脏外科发展最为活跃的领域之一。虽然有十几个问题推动着这一发展，但有两个问题似乎起着最重要的作用：第一，缺乏证据支持经皮导管治疗持续性和长期持续性房颤患者的方法。这些数据的匮乏为外科界提供了前所未有的机会来挑战指南并改变手术干预的适应症。因此，大型多中心前瞻性临床研究以及诚实、清晰的数据报告至关重要。第二，一种协作方法引发了一场期待已久的关于房颤心脏团队治疗方法的辩论，类似于关于冠状动脉疾病和经导管瓣膜的辩论。适当的患者选择和量身定制的治疗方案肯定会带来更好的治疗效果和患者满意度，同时合理利用总是有限的机构资源。与其他微创外科消融术的综述不同，本综述的目的是向医学专业人员介绍两种截然不同的方法。第一种是纯粹的外科手术，即使用双极能量源单独进行肺静脉隔离并同时切除左心耳——这是房颤最重要的临床试验之一“房颤导管消融与外科消融治疗（FAST）试验”中的一种首选方法。第二种代表了针对这个问题最复杂的方法：心脏外科医生和电生理学家的多学科联合努力。“融合手术”包括心内膜和心外膜单极消融，将微创内镜手术与电解剖标测结合在一起，融合了两者的优势。一个目标仍然是：帮助那些急需持久缓解的患者。
