Lednev P V, Belov Yu V, Komarov R N, Stonogin A V, Katkov A I
Petrovsky Russian Research Center of Surgery.
Sechenov First Moscow State Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2017(6):16-21. doi: 10.17116/hirurgia2017616-21.
To compare an efficacy of primary surgical (epicardial bipolar pulmonary veins isolation) and pharmacological (amiodarone) prevention of postoperative atrial fibrillation.
The study included 117 patients with coronary artery disease without previous paroxysms of atrial fibrillation who were randomized into 3 groups. The first (I) group (n=39) included patients who underwent coronary artery bypass grafting without radiofrequency ablation of pulmonary veins and prophylactic amiodarone administration. The second (II) group (n=38) consisted of patients who received amiodarone as a prevention of postoperative atrial fibrillation. In the third (III) group (n=40) simultaneous CABG and pulmonary veins isolation were made.
The incidence of atrial fibrillation in early postoperative period was significantly lower in the 3rd group compared with control group (90% vs 69.2%, p=0.021). 1-year freedom from atrial fibrillation was 97.5% in group III vs. 84.2% in group II (p=0.004). In group I the incidence of early postoperative atrial fibrillation was 30.8% with following decrease to 17.9% in 12 months.
Simultaneous preventive pulmonary veins isolation during CABG is safe and effective, significantly reduces duration of hospital-stay and incidence of postoperative atrial fibrillation.
比较原发性外科手术（心外膜双极肺静脉隔离术）和药物治疗（胺碘酮）预防术后房颤的疗效。
该研究纳入了117例无房颤发作史的冠心病患者，随机分为3组。第一组（I组，n = 39）包括接受冠状动脉搭桥术但未进行肺静脉射频消融且未预防性使用胺碘酮的患者。第二组（II组，n = 38）由接受胺碘酮预防术后房颤的患者组成。第三组（III组，n = 40）同时进行冠状动脉搭桥术和肺静脉隔离术。
与对照组相比，第三组术后早期房颤的发生率显著降低（90%对69.2%，p = 0.021）。III组1年无房颤率为97.5%，II组为84.2%（p = 0.004）。I组术后早期房颤的发生率为30.8%，12个月后降至17.9%。
冠状动脉搭桥术期间同时进行预防性肺静脉隔离术安全有效，可显著缩短住院时间并降低术后房颤的发生率。
