Departments of Cardiology and Medical Science, Uppsala University, SE-751?85 Uppsala, Sweden.
Faculty of Medicine, Department of Public Health and Clinical Medicine (Heart centre) Umeå University, SE-901 87 Umeå, Sweden.
Europace. 2018 Nov 1;20(FI_3):f343-f350. doi: 10.1093/europace/eux253.
Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation.
Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the double-blinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12 month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7), P = 0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4 (44.6-52.2), P = 0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12 months; mean 45.4 (42.0-48.7) vs. mean 40.5 (35.5-45.6), P = 0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5), P = 0.581).
Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure.
尽管没有令人信服的信息表明生活质量（QOL）和临床获益得到改善，但在接受二尖瓣手术（MVS）的患者中同时进行房颤（AF）的外科消融术几乎已成为常规。因此，在 MVS 中进行或不进行心外膜左心房冷冻消融术，对患者的生活质量进行了评估。
在 SWEDMAF 双盲多中心试验中，65 例永久性 AF 患者随机分为 MVS 联合左心房冷冻消融术或单纯 MVS 组，在 6 个月和 12 个月的随访中，65 例患者回复了简短形式 36 项 QOL 调查。在 12 个月的随访中，接受 MVS 联合冷冻消融术的患者与仅接受 MVS 术的患者相比，生活质量评分在生理成分综合评分方面无显著差异，平均值分别为 42.8（95%置信区间 38.3-47.3）和 44.0（40.1-47.7），P=0.700；在心理成分综合评分方面也无显著差异，平均值分别为 53.1（49.7-56.4）和 48.4（44.6-52.2），P=0.075。所有患者，无论接受何种手术，在手术后的生活质量均与年龄匹配的瑞典一般人群相同。窦性心律患者的生理成分综合评分在 12 个月时也与 AF 患者无差异，平均值分别为 45.4（42.0-48.7）和 40.5（35.5-45.6），P=0.096；心理成分综合评分也无差异，平均值分别为 51.0（48.0-54.1）和 49.6（44.6-54.5），P=0.581。
左心房冷冻消融术联合 MVS 并不能改善永久性 AF 患者的健康相关 QOL，这一发现令人对推荐采用这种联合手术的建议产生质疑。
