基于连续监测对二尖瓣手术患者同期阵发性心房颤动消融的评估：不同的消融灶设置有影响吗？
Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?
作者信息
Bogachev-Prokophiev Alexandr, Zheleznev Sergey, Pivkin Alexey, Pokushalov Evgeny, Romanov Alexander, Nazarov Vladimir, Karaskov Alexander
机构信息
Heart Valves Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
出版信息
Interact Cardiovasc Thorac Surg. 2014 Feb;18(2):177-81; discussion 182. doi: 10.1093/icvts/ivt461. Epub 2013 Nov 19.
OBJECTIVES
The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery.
METHODS
Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n = 27) and the LAM group (n = 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of <0.5% were considered AF free (responders). The mean follow-up was 18.6 months (standard deviation 2.1 months), and the patient' data were evaluated every 3 months.
RESULTS
All patients were alive at discharge. No procedure-related complications occurred for either the ablation or the loop recorder implantation. Mean aortic clamping and ablation times were significantly longer in the LAM group than in the PVI group. The incidence of early AF paroxysm recurrence was significantly higher in the PVI group than in the LAM group (62.9 vs 24.0%, P < 0.001). At 20 months after surgery, 15 (55.6%) of the 27 patients in the PVI group and 22 (88.0%) of the 25 patients in the LAM group had no documented atrial arrhythmias and were considered responders (AF burden <0.5%). The mean AF burden during all follow-up periods was significantly lower in the LAM group (23.6 ± 8.7%) than in the PVI group (6.8 ± 2.2%) (P < 0.001).
CONCLUSIONS
According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.
目的
二尖瓣手术患者中阵发性心房颤动（AF）的联合消融技术疗效仍存在争议。本前瞻性、随机、单中心研究的目的是比较二尖瓣手术期间阵发性AF患者单纯肺静脉隔离（PVI）与左心房迷宫（LAM）手术的效果。
方法
2009年2月至2011年6月期间，52例平均年龄为54.2岁（标准差7.2岁）的患者接受了二尖瓣手术及阵发性AF的双极射频消融。患者被随机分为PVI组（n = 27）和LAM组（n = 25）。术后植入可植入式环路记录仪进行连续心电图（ECG）监测。AF负荷（AF%）<0.5%的患者被视为无AF（反应者）。平均随访时间为18.6个月（标准差2.1个月），每3个月评估患者数据。
结果
所有患者出院时均存活。消融或环路记录仪植入均未发生与手术相关的并发症。LAM组的平均主动脉阻断和消融时间显著长于PVI组。PVI组早期AF发作复发率显著高于LAM组（62.9%对24.0%，P < 0.001）。术后20个月，PVI组27例患者中有15例（55.6%）、LAM组25例患者中有22例（88.0%）无记录到的房性心律失常，被视为反应者（AF负荷<0.5%）。所有随访期间LAM组的平均AF负荷（23.6 ± 8.7%）显著低于PVI组（6.8 ± 2.2%）（P < 0.001）。
结论
根据连续ECG监测数据，二尖瓣手术的阵发性AF患者接受联合LAM手术后无AF的比例显著高于PVI术后。
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