Pecha Simon, Ghandili Susanne, Hakmi Samer, Willems Stephan, Reichenspurner Hermann, Wagner Florian Mathias
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Semin Thorac Cardiovasc Surg. 2017;29(3):294-298. doi: 10.1053/j.semtcvs.2017.08.015. Epub 2017 Aug 25.
According to guidelines, atrial fibrillation (AF) ablation success should be measured by 24-hour Holter electrocardiogram (ECG). However, information on long-term success, especially obtained by 24-hour Holter ECG, is rare. We therefore analyzed rhythm course and long-term outcomes of our patients undergoing concomitant surgical AF ablation. Between January 2003 and April 2011, 486 patients underwent concomitant surgical AF ablation in our institution. Patients with 24-hour Holter ECG rhythm status available between 5 and 10 years postoperatively were included in this retrospective data analysis (n = 155). Ablation lesions were limited to either a pulmonary vein isolation (n = 31, 20%), a more complex left atrial lesion set (n = 89, 57%), or biatrial lesions (n = 35, 23%). Primary end point of the study was freedom from AF during long-term follow-up. Mean patient age was 68.1 ± 8.4 years; 57.4% were male. Mean follow-up time was 5.9 years. Surgical AF ablation provided freedom from AF rate of 56.6% during long-term follow-up, with significantly better results in patients with paroxysmal than in those with persistent AF (67.2% vs 51.8% P = 0.03). A stable rhythm course was observed during follow-up, without statistically significant differences between 12 months and latest follow-up (63.2% vs 56.6%; P = 0.25). In multivariate analysis, preoperative paroxysmal AF, duration of AF, and left atrial diameter were predictors of long-term ablation success. Surgical AF ablation provided freedom from AF rate of 56.6% during long-term follow-up. Statistically significant predictors of ablation success at latest follow-up were preoperative paroxysmal AF, duration of AF, and a preoperative smaller left atrial diameter.
根据指南，房颤（AF）消融术的成功应以24小时动态心电图（ECG）来衡量。然而，关于长期成功率的信息，尤其是通过24小时动态心电图获得的信息却很少。因此，我们分析了接受同期外科房颤消融术患者的心律进程和长期预后。2003年1月至2011年4月期间，我院有486例患者接受了同期外科房颤消融术。术后5至10年有24小时动态心电图心律状态记录的患者被纳入此次回顾性数据分析（n = 155）。消融病变仅限于肺静脉隔离（n = 31，20%）、更复杂的左心房病变组（n = 89，57%）或双心房病变（n = 35，23%）。该研究的主要终点是长期随访期间无房颤。患者平均年龄为68.1±8.4岁；男性占57.4%。平均随访时间为5.9年。外科房颤消融术在长期随访期间的无房颤率为56.6%，阵发性房颤患者的效果明显优于持续性房颤患者（67.2%对51.8%，P = 0.03）。随访期间观察到心律进程稳定，12个月时与最近一次随访之间无统计学显著差异（63.2%对56.6%；P = 0.25）。多因素分析显示，术前阵发性房颤、房颤持续时间和左心房直径是长期消融成功的预测因素。外科房颤消融术在长期随访期间的无房颤率为56.6%。最近一次随访时消融成功的统计学显著预测因素为术前阵发性房颤、房颤持续时间和术前较小的左心房直径。
