Hu Qiu-Ming, Li Yan, Xu Chun-Lei, Han Jie, Zhang Hai-Bo, Han Wei, Meng Xu
Department of Cardiac Surgery, Beijing Anzhen Hospital of the Capital University of Medical Sciences, Beijing, People's Republic of China.
Department of Cardiac Surgery, Beijing Anzhen Hospital of the Capital University of Medical Sciences, Beijing, People's Republic of China.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2174-80. doi: 10.1016/j.jtcvs.2013.10.054. Epub 2014 Mar 31.
The purpose of the present study was to assess the efficacy of the long-term results after video-assisted pulmonary vein isolation and left atrial appendage excision for lone atrial fibrillation (AF) and to determine the most significant risk factors for the long-term results.
From December 2006 to December 2012, 332 consecutive patients with lone AF underwent minimally invasive surgical ablation at our center. Of the 332 patients, 91, who had undergone video-assisted pulmonary vein isolation>5 years earlier, were evaluated in the present study (48 with paroxysmal AF, 21 with persistent AF, and 22 with long-standing persistent AF). The median follow-up period was 66 months. The primary endpoint was the success rate of video-assisted pulmonary vein isolation, defined as the absence of any atrial arrhythmia recurrence lasting >30 seconds at the clinical visit and on the electrocardiogram or long-term cardiac rhythm recording after discharge.
During the follow-up period, 1 patient (1.1%) experienced a stroke and 4 (4.4%) died of noncardiac disease. At the 5-year follow-up point, 43 of 78 patients (55.1%) were in normal sinus rhythm. Of the 39 patients with paroxysmal AF and 39 with nonparoxysmal AF, 27 (69.2%) and 16 (44.1%) were in normal sinus rhythm, respectively. The results of the univariate and multivariate analyses of the preoperative risk factors for AF recurrence showed a left atrial diameter of ≥44 mm (hazard ratio, 5.56; 95% confidence interval, 1.68-18.387; P=.005) and an AF duration of ≥31.5 months (hazard ratio, 3.67; 95% confidence interval, 1.50-8.95; P=.004) were the most significant independent risk factors.
Patients with lone AF with a large preoperative left atrial diameter and long AF duration will not be suitable for video-assisted pulmonary vein isolation alone and might need to undergo ablation of the lesions.
本研究旨在评估电视辅助肺静脉隔离术和左心耳切除术治疗孤立性心房颤动（房颤）的长期疗效，并确定影响长期疗效的最重要危险因素。
2006年12月至2012年12月，连续332例孤立性房颤患者在本中心接受了微创手术消融治疗。在这332例患者中，91例在5年多以前接受了电视辅助肺静脉隔离术，在本研究中接受评估（阵发性房颤48例，持续性房颤21例，长期持续性房颤22例）。中位随访期为66个月。主要终点是电视辅助肺静脉隔离术的成功率，定义为在临床就诊时以及出院后的心电图或长期心律记录中无持续超过30秒的房性心律失常复发。
随访期间，1例患者（1.1%）发生中风，4例（4.4%）死于非心脏疾病。在5年随访时，78例患者中有43例（55.1%）为正常窦性心律。在39例阵发性房颤患者和39例非阵发性房颤患者中，分别有27例（69.2%）和16例（44.1%）为正常窦性心律。房颤复发术前危险因素的单因素和多因素分析结果显示，左心房直径≥44 mm（风险比，5.56；95%置信区间，1.68 - 18.387；P = 0.005）和房颤持续时间≥31.5个月（风险比，3.67；95%置信区间，1.50 - 8.95；P = 0.004）是最显著的独立危险因素。
术前左心房直径大且房颤持续时间长的孤立性房颤患者不适合单独进行电视辅助肺静脉隔离术，可能需要进行病变消融。
