Cardiology Department, University Hospital, Maastricht, The Netherlands ;
Cardiothoracic Surgery University Hospital, Maastricht, The Netherlands.
Ann Cardiothorac Surg. 2014 Jan;3(1):38-44. doi: 10.3978/j.issn.2225-319X.2013.12.10.
We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial technique for the treatment of lone atrial fibrillation.
Between 2009 and 2012, a cohort of 78 consecutive patients (median age 60.5 years, 77% male) underwent ablation of atrial fibrillation (AF) as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3 months, 6 months, 1 year and yearly thereafter. All patients reached 1-year follow-up. Median follow-up was 24 months [interquartile range 12-36].
No death or conversion to cardiopulmonary bypass occurred. No patient demonstrated paralysis of the phrenic nerve. Overall, the incidence of perioperative complications was 8% (n=6). At the end of follow-up, sixty-eight patients (87%) were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting longer than 30 seconds and off antiarrhythmic drugs (ADD). Among patients with long-standing persistent AF, 15 (100%) were in SR and off AAD. Success rates were 82% (n=28) in persistent and 76% (n=22) in paroxysmal AF (P=0.08). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up.
Thoracoscopic hybrid epicardial endocardial technique proved to be effective and safe in the treatment of LAF and to represent an important new suitable option to treat stand-alone AF. Our findings need to be confirmed by further larger studies.
我们评估了杂交胸腔镜心外膜心内膜技术治疗孤立性心房颤动的安全性和有效性。
在 2009 年至 2012 年间，78 例连续患者（中位年龄 60.5 岁，77%为男性）接受了房颤（AF）消融治疗，作为一种独立的程序，采用胸腔镜杂交心外膜心内膜技术。所有患者在 3 个月、6 个月、1 年和此后每年接受连续 7 天的动态心电图监测。所有患者均达到 1 年随访。中位随访时间为 24 个月[四分位间距 12-36]。
无死亡或转为心肺旁路。无患者出现膈神经麻痹。总的来说，围手术期并发症的发生率为 8%（n=6）。在随访结束时，68 例患者（87%）为窦性节律（SR），无 AF、心房扑动或持续 30 秒以上的房性心动过速发作，且未服用抗心律失常药物（ADD）。在持续性长程 AF 患者中，15 例（100%）为 SR，且未服用 AAD。持续性 AF 的成功率为 82%（n=28），阵发性 AF 为 76%（n=22）（P=0.08）。在随访期间，无患者死亡，无血栓栓塞/出血事件或与手术相关的并发症发生。
胸腔镜杂交心外膜心内膜技术在治疗孤立性房颤中被证明是有效和安全的，是治疗孤立性房颤的一种重要的新的合适选择。我们的研究结果需要进一步的更大规模的研究来证实。
