Curnis Antonio, Bisleri Gianluigi, Bontempi Luca, Salghetti Francesca, Cerini Manuel, Lipari Alessandro, Pagnoni Carlo, Vassanelli Francesca, Muneretto Claudio
Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy.
Division of Cardiac Surgery, Spedali Civili, University of Brescia Medical School, Brescia, Italy.
J Atr Fibrillation. 2013 Jun 30;6(1):775. doi: 10.4022/jafib.775. eCollection 2013 Jun-Jul.
During the past decades there has been a consistent evolution of both surgical and catheter-based techniques for the treatment of stand-alone atrial fibrillation, as alternatives or in combination with anti-arrhythmic drugs. Transcatheter ablation has significantly improved outcomes, despite often requiring multiple procedures and with limited success rates especially in presence of persistent atrial fibrillation. Surgical procedures have dramatically evolved from the original cut-and-sew Maze operation, allowing nowadays for closed-chest epicardial ablations on the beating heart. Recently, the concept of a close collaboration between the cardiac surgeon and the electrophysiologist has emerged as an intriguing option in order to overcome the drawbacks and suboptimal results of both techniques; therefore, the hybrid approach has been proposed as a potentially more successful strategy, allowing for a patient-tailored therapeutical approach. We reviewed the recent advancements either from the transcatheter and surgical standpoint, with a peculiar focus on the current option to merge both techniques along with an up-to-date review of the preliminary clinical experiences with the hybrid, surgical-transcatheter treatment of stand-alone atrial fibrillation.
在过去几十年中，用于治疗孤立性心房颤动的外科手术和基于导管的技术都在持续发展，可作为抗心律失常药物的替代方法或与之联合使用。经导管消融显著改善了治疗效果，尽管通常需要多次手术，且成功率有限，尤其是在持续性心房颤动的情况下。外科手术已从最初的切割缝合迷宫手术发生了巨大演变，如今已能在跳动的心脏上进行闭式胸腔心外膜消融。最近，心脏外科医生和电生理学家密切合作的概念作为一种有趣的选择出现，以克服这两种技术的缺点和不理想的结果；因此，混合方法被提议作为一种可能更成功的策略，允许采用针对患者的治疗方法。我们从经导管和外科手术的角度回顾了最近的进展，特别关注将这两种技术合并的当前选择，以及对孤立性心房颤动的外科 - 经导管混合治疗的初步临床经验的最新综述。
