Pecha Simon, Ahmadzade Teymour, Schäfer Timm, Subbotina Irina, Steven Daniel, Willems Stephan, Reichenspurner Hermann, Wagner Florian Mathias
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Eur J Cardiothorac Surg. 2014 Jul;46(1):67-71. doi: 10.1093/ejcts/ezt602. Epub 2014 Jan 19.
Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%).
Between July 2003 and August 2011, 59 patients with severely reduced LVEF underwent concomitant surgical AF ablation, by either left atrial (LA) lesion set or bilateral pulmonary vein isolation in patients with paroxysmal AF, and biatrial lesion set in patients with persistent AF. Follow-up echocardiography (ECG) was conducted after 12 months; rhythm monitoring was accomplished by either 24-h Holter echocardiography or event recorder monitoring.
The patients' mean age was 68 ± 9 years (male patients, 71%). Paroxysmal AF was present in 24 (41%) and persistent AF in 35 (59%) patients. No ablation-related adverse events occurred. The one-year survival rate was 95% without differences in patients with and without restoration of sinus rhythm (SR). The overall rate of SR was 54% after 1 year, showing a superior result in patients with preoperative paroxysmal AF compared with those with preoperative persistent AF (70 vs 41%, P < 0.001). LVEF improved from 29 ± 8% preoperatively to 39 ± 7% after 12 months of follow-up. The improvement in LVEF was significantly higher in patients with restored SR than in those with AF (16 vs 5%; P < 0.001). Only patients with restoration of SR showed a statistically significant reduction in New York Heart Association functional class at the 12-month follow-up (P = 0.0013).
Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
同期进行心房颤动（AF）的外科消融术是一种安全可行的手术。然而，许多外科医生不愿在心力衰竭患者中开展该手术。我们研究了左心室射血分数严重降低（LVEF<35%）的患者进行AF消融术的安全性和有效性。
在2003年7月至2011年8月期间，59例LVEF严重降低的患者接受了同期外科AF消融术，阵发性AF患者采用左心房（LA）消融或双侧肺静脉隔离术，持续性AF患者采用双心房消融术。术后12个月进行随访超声心动图（ECG）检查；通过24小时动态心电图或事件记录仪监测进行心律监测。
患者的平均年龄为68±9岁（男性患者占71%）。24例（41%）为阵发性AF，35例（59%）为持续性AF。未发生与消融相关的不良事件。1年生存率为95%，窦性心律（SR）恢复和未恢复的患者之间无差异。1年后SR的总体发生率为54%，术前阵发性AF患者的结果优于术前持续性AF患者（70%对41%，P<0.001）。随访12个月后，LVEF从术前的29±8%提高到39±7%。SR恢复的患者LVEF的改善明显高于AF患者（16%对5%；P<0.001）。只有SR恢复的患者在12个月随访时纽约心脏协会心功能分级有统计学意义的降低（P=0.0013）。
对于LVEF严重降低的患者，外科AF消融术是安全可行的。SR的恢复导致LVEF显著改善，并缓解临床心力衰竭症状，术后若AF持续则未观察到这些情况。
