Churyla Andrei, Iddriss Adam, Andrei Adin-Christian, Kruse Jane, Malaisrie S Chris, Passman Rod, Li Zhi, Lee Richard, McCarthy Patrick M
Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois; Department of Surgery, Yale University, Yale-New Haven Hospital, New Haven, Connecticut.
Ann Thorac Surg. 2017 Jun;103(6):1858-1865. doi: 10.1016/j.athoracsur.2016.10.017. Epub 2016 Dec 22.
Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients.
From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39%) had preoperative atrial fibrillation, and of those, 724 (86%) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed.
Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13% versus 7%; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72% BA versus 75% LA; p = 0.50), postoperative ablation (7% BA versus 5% LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79% BA versus 69% LA; p = 0.09), and no difference in permanent pacemaker placement (10% versus 12%; p = 0.57).
Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.
在进行外科房颤消融时，与仅行左心房（LA）消融相比，采用双心房（BA）消融术后并发症是否增加存在争议，一些研究表明二者疗效相似。本研究比较二尖瓣手术患者中行BA和LA消融的临床结局。
2004年至2014年，在单一中心有2137例患者接受了二尖瓣手术，部分患者还接受了其他手术。其中，836例（39%）术前有房颤，这些患者中724例（86%）接受了房颤消融手术；257例患者采用BA消融，359例采用LA消融。对BA组和LA组患者进行倾向得分匹配。
基线差异包括BA组术后并发症更多，具体而言，永久性起搏器植入率（13%对7%；p = 0.006）。两组在停用抗心律失常药物后无房颤生存率（BA组72%对LA组75%；p = 0.50）、术后再次消融率（BA组7%对LA组5%；p = 0.20）、卒中发生率（每10人年0.11对0.11；p = 0.91）及生存率方面相似。匹配后，LA组患者术后再次消融的无发生率更高（p = 0.015），但在停用抗心律失常药物后无房颤生存率方面无差异（BA组79%对LA组69%；p = 0.09），在永久性起搏器植入率方面也无差异（10%对12%；p = 0.57）。
接受二尖瓣手术并进行LA或BA消融的患者在结局、生存率及并发症方面相似。对于接受二尖瓣手术同时行消融的患者，将消融局限于LA是BA消融的一种有效替代方案。
