Badhwar Vinay, Rankin J Scott, Damiano Ralph J, Gillinov A Marc, Bakaeen Faisal G, Edgerton James R, Philpott Jonathan M, McCarthy Patrick M, Bolling Steven F, Roberts Harold G, Thourani Vinod H, Suri Rakesh M, Shemin Richard J, Firestone Scott, Ad Niv
Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia.
Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia.
Ann Thorac Surg. 2017 Jan;103(1):329-341. doi: 10.1016/j.athoracsur.2016.10.076.
Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion).
心房颤动（AF）的外科消融术可在不增加手术死亡率或严重并发症风险的情况下进行，并且建议在同期进行二尖瓣手术时实施以恢复窦性心律。（I类，A级）AF的外科消融术可在不增加手术死亡率或严重并发症风险的情况下进行，并且建议在同期进行单纯主动脉瓣置换术、单纯冠状动脉旁路移植术以及主动脉瓣置换加冠状动脉旁路移植手术时实施以恢复窦性心律。（I类，B级非随机）对于I/III类抗心律失常药物或导管消融治疗或两者均无效的无结构性心脏病的症状性AF，作为主要的独立手术进行外科消融以恢复窦性心律是合理的。（IIa类，B级随机）对于无结构性心脏病的症状性持续性或长期持续性AF，作为独立手术，与单独肺静脉隔离相比，使用Cox迷宫III/IV术式进行外科消融是合理的。（IIa类，B级非随机）不建议仅通过肺静脉隔离对存在左心房扩大（≥4.5 cm）或中度以上二尖瓣反流的症状性AF进行外科消融。（III类，无获益，C级专家意见）在进行AF外科消融时，为预防纵向血栓栓塞性疾病，合理的做法是同时进行左心耳切除或封堵。（IIa类，C级有限数据）对于AF患者，在同期进行心脏手术时，为预防纵向血栓栓塞性疾病，合理的做法是通过手术处理左心耳。（IIa类，C级专家意见）在AF治疗中，多学科心脏团队评估、治疗规划及长期随访有助于优化患者预后。（I类，C级专家意见）
