Al-Atassi Talal, Kimmaliardjuk Donna-May, Dagenais Camille, Bourke Michael, Lam Buu-Khanh, Rubens Fraser D
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Ann Thorac Surg. 2017 Aug;104(2):515-522. doi: 10.1016/j.athoracsur.2016.11.081. Epub 2017 Mar 3.
This study evaluates the safety and efficacy of concomitant atrial fibrillation (AF) ablation in patients with AF undergoing coronary artery bypass grafting (CABG) or aortic valve replacement (AVR) or both.
This is a single-center retrospective study of patients with AF presenting for CABG or AVR or both between 2009 and 2013. They were divided into an ablation group that underwent concomitant AF ablation and a control group that did not. Follow-up data were obtained using telephone interviews. The data were 100% complete with a median follow-up of 30 months.
A total of 375 patients with AF presented for CABG (44%), AVR (27%), or CABG and AVR (29%). The ablation (129 patients) and control (246 patients) groups had similar baseline characteristics. The ablation group had significantly longer cardiopulmonary bypass and cross-clamp times, adding a mean of 31 ± 3 and 22 ± 3 minutes (p < 0.01 for both), respectively. There were similar unadjusted rates of hospital mortality (4.7% versus 5.3%, p = 0.79), stroke (3.1% versus 3.3%, p = 0.94), and reopening (4.7% versus 6.5%, p = 0.46) between the groups. The intensive care and hospital length of stays were similar. The ablation group had a lower incidence of postoperative AF (27% versus 78%, p < 0.01). Adjusted operative mortality was similar, but the intervention group had significantly lower odds of postoperative AF (odds ratio 0.11, p < 0.01). Although there was no difference in mid-term survival, the ablation group had higher mid-term AF-free survival (p < 0.01) and a trend toward higher anticoagulation-free (p = 0.09) and stroke-free survival (p = 0.08).
Concomitant AF ablation in patients with AF undergoing CABG or AVR or both does not increase perioperative rates of mortality or morbidity. Moreover, concomitant AF ablation is effective at reducing postoperative AF burden and increases mid-term AF-free survival.
本研究评估了在接受冠状动脉旁路移植术（CABG）或主动脉瓣置换术（AVR）或两者兼有的房颤（AF）患者中进行同期房颤消融的安全性和有效性。
这是一项对2009年至2013年间因CABG或AVR或两者兼而有之而就诊的房颤患者进行的单中心回顾性研究。他们被分为接受同期房颤消融的消融组和未接受消融的对照组。通过电话访谈获得随访数据。数据100%完整，中位随访时间为30个月。
共有375例房颤患者因CABG（44%）、AVR（27%）或CABG和AVR（29%）就诊。消融组（129例患者）和对照组（246例患者）具有相似的基线特征。消融组的体外循环和主动脉阻断时间明显更长，分别平均增加31±3分钟和22±3分钟（两者p均<0.01）。两组间未调整的住院死亡率（4.7%对5.3%，p = 0.79）、卒中发生率（3.1%对3.3%，p = 0.94）和再次手术率（4.7%对6.5%，p = 0.46）相似。重症监护和住院时间相似。消融组术后房颤的发生率较低（27%对78%，p < 0.01）。调整后的手术死亡率相似，但干预组术后房颤的几率显著更低（比值比0.11，p < 0.01）。虽然中期生存率无差异，但消融组的中期无房颤生存率更高（p < 0.01），且在无抗凝（p = 0.09）和无卒中生存率方面有升高趋势（p = 0.08）。
在接受CABG或AVR或两者兼有的房颤患者中进行同期房颤消融不会增加围手术期死亡率或发病率。此外，同期房颤消融在减轻术后房颤负担方面有效，并可提高中期无房颤生存率。
