Pinho-Gomes Ana C, Amorim Mário J, Oliveira Sílvia M, Azevedo Luís, Almeida Jorge, Monteiro Vítor, Maciel Maria Júlia, Pinho Paulo, Leite-Moreira Adelino F
Departmentos de Fisiologia e Cirurgia Cardiotorácica, de Ciências da Informação e da Decisão em Sáude (CIDES), Unidade de Investigação e Desenvolvimento Cardiovascular e Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde (CINTESIS) da Faculdade de Medicina da Universidade do Porto e Departamentos de Cirurgia Cardiotorácica e de Cardiologia do Centro Hospitalar S. João, Porto, Portugal.
Rev Port Cir Cardiotorac Vasc. 2014 Jan-Mar;21(1):11-20.
We present the experience of our centre with radiofrequency ablation of atrial fibrillation concomitantly with cardiac surgery Methods: 170 patients underwent atrial fibrillation ablation with uni/bipolar-radiofrequency. They were followed for 3-months and then as appropriate for the cardiac disease. In 2013, patients still alive underwent rhythm monitoring with ECG and 24-hour tape if in sinus rhythm
Mean age was 65 years old and 42% of the patients were male. Paroxysmal AF was rare (7%). Most patients had preserved ejection fraction and dilated left atria (diameter 53.2±7.5 mm). The most common indication for cardiac surgery was valve disease. More than 75% of the patients underwent prophylactic closure of the left atrial appendage. Pulmonary vein isolation was performed in all patients, followed by other left atrial ablation lines. Overall, surgical complications were rare, being the most frequent pacemaker implantation (15%). Median length of stay was 9 days (p25-p75:7-14). At discharge, 69% of the patients were in sinus rhythm, being 90% on anticoagulation and 69% on amiodarone. In-hospital mortality was less than 3% (5 patients), none of them related to the ablation procedure. At 3 months, 50% of the patients were in sinus rhythm, being 92% on anticoagulation and 75% on antiarrhythmic drugs. Direct current cardioversion was successful in 8 of 12 patients. In the multivariate analysis, being in sinus rhythm at discharge was the single independent predictor of maintaining sinus rhythm at 3 months. In 2013 (469 patients-year), 40% of the patients were in sinus rhythm, being 80% on anticoagulation and 45% on antiarrhythmic drugs.
Concurrent atrial fibrillation ablation with radiofrequency achieves satisfactory and stable recovery of sinu rhythm without adding significant operative risk and post-operative complications.
我们介绍本中心在心脏手术同时进行心房颤动射频消融的经验。方法：170例患者接受单极/双极射频心房颤动消融术。对他们进行了3个月的随访，然后根据心脏病情况进行适当随访。2013年，仍存活的患者若处于窦性心律，则进行心电图和24小时动态心电图心律监测。结果：平均年龄为65岁，42%的患者为男性。阵发性房颤很少见（7%）。大多数患者射血分数保留，左心房扩大（直径53.2±7.5mm）。心脏手术最常见的适应证是瓣膜病。超过75%的患者接受了左心耳预防性封堵。所有患者均进行了肺静脉隔离，随后进行了其他左心房消融线。总体而言，手术并发症很少见，最常见的是起搏器植入（15%）。中位住院时间为9天（第25百分位数-第75百分位数：7-14天）。出院时，69%的患者处于窦性心律，90%的患者接受抗凝治疗，69%的患者服用胺碘酮。住院死亡率低于3%（5例患者），均与消融手术无关。3个月时，50%的患者处于窦性心律，92%的患者接受抗凝治疗，75%的患者服用抗心律失常药物。12例患者中有8例直流电复律成功。在多变量分析中，出院时处于窦性心律是3个月时维持窦性心律的唯一独立预测因素。2013年（469患者年），40%的患者处于窦性心律，80%的患者接受抗凝治疗，45%的患者服用抗心律失常药物。结论：射频消融同时进行心房颤动消融可实现窦性心律的满意且稳定恢复，而不会增加显著的手术风险和术后并发症。
