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分期与同期胸腔镜杂交消融治疗持续性心房颤动对房性心律失常复发时间无影响。

Staged versus Simultaneous Thoracoscopic Hybrid Ablation for Persistent Atrial Fibrillation Does Not Affect Time to Recurrence of Atrial Arrhythmia.

作者信息

Richardson Travis D, Shoemaker M Benjamin, Whalen S Patrick, Hoff Steven J, Ellis Christopher R

机构信息

Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Division of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.

出版信息

J Cardiovasc Electrophysiol. 2016 Apr;27(4):428-34. doi: 10.1111/jce.12906. Epub 2016 Jan 29.

Abstract

INTRODUCTION

Totally thoracoscopic (TT) epicardial ablation combined with endocardial catheter ablation is an emerging treatment for persistent AF. The effects of timing of the TT and endocardial portion on AT/AF recurrence are not known.

METHODS

We retrospectively analyzed patients undergoing TT staged versus simultaneous hybrid AF ablation at our institution. Arrhythmia-free outcome was compared using time to recurrence (AF or AT greater than 30 seconds after a 3-month blanking period from endocardial ablation) at 12 months. All subjects had continuous ILR or PM monitoring.

RESULTS

Eighty-three patients (52 same-day, 31 staged) underwent TT hybrid AF ablation. Recurrence was observed in 23 (29%) patients at a median time of 147 days (IQR 91,238). In univariate analysis, a staged approach significantly increased the likelihood of detecting incomplete PVI (OR 6 [95% CI 2-17] P = 0.001). However, only longstanding persistent AF (LSP-AF) status predicted recurrence (HR 4 [95% CI 1.4-12] P = 0.01). Neither a staged approach (HR 1.0 [95% CI 0.4-2.4] P = 0.9), nor detection of incomplete PVI (HR 0.9 [95% CI 0.4-2.3] P = 0.8) predicted time to first AF/AT recurrence.

CONCLUSIONS

Staged hybrid ablation of AF significantly increases the likelihood of discovering incomplete PVI at the time of endocardial mapping versus a same-day procedure. However, the staged approach did not improve time to first AT/AF recurrence.

摘要

引言

完全胸腔镜下心外膜消融联合心内膜导管消融是一种用于持续性房颤的新兴治疗方法。胸腔镜部分和心内膜部分手术时机对房性心动过速/房颤复发的影响尚不清楚。

方法

我们回顾性分析了在本机构接受分期或同期混合房颤消融的胸腔镜手术患者。使用从心内膜消融开始3个月空白期后12个月内复发时间(房颤或房性心动过速持续超过30秒)比较无心律失常结局。所有受试者均进行连续的植入式loop记录器(ILR)或起搏器(PM)监测。

结果

83例患者(52例同期,31例分期)接受了胸腔镜混合房颤消融。23例(29%)患者出现复发,中位复发时间为147天(四分位间距91,238)。单因素分析中,分期手术显著增加了检测到肺静脉隔离不完全的可能性(比值比6 [95%可信区间2 - 17] P = 0.001)。然而,只有长期持续性房颤(LSP - AF)状态可预测复发(风险比4 [95%可信区间1.4 - 12] P = 0.01)。分期手术(风险比1.0 [95%可信区间0.4 - 2.4] P = 0.9)和肺静脉隔离不完全的检测(风险比0.9 [95%可信区间0.4 - 2.3] P = 0.8)均不能预测首次房颤/房性心动过速复发时间。

结论

与同期手术相比,分期混合消融房颤在进行心内膜标测时显著增加了发现肺静脉隔离不完全的可能性。然而,分期手术并未改善首次房性心动过速/房颤复发时间。

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