Budera Petr, Osmancik Pavel, Talavera David, Kraupnerova Anna, Fojt Richard, Zdarska Jana, Vanek Tomas, Straka Zbynek
Cardiocenter, Department of Cardiac Surgery, Third Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Cardiocenter, Department of Cardiology, Third Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Interact Cardiovasc Thorac Surg. 2018 Jan 1;26(1):77-83. doi: 10.1093/icvts/ivx248.
Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy; however, data regarding its efficacy and safety are still limited.
Patients with non-paroxysmal AF were enrolled. First, a thoracoscopic, epicardial isolation of pulmonary veins and the left atrial posterior wall ('box lesion') was performed; a novel unipolar/bipolar radiofrequency device was used. Moreover, in 12 patients enrolled thereafter, the left atrial appendage was occluded. Electrophysiological evaluation and catheter ablation were performed 2-3 months later, with the goal of verifying or completing (if needed) the box lesion and ablation of the ganglionated plexi and the cavotricuspid isthmus. Outcomes were assessed using 1-week and 24-h Holter monitoring, repeated echocardiography and laboratory measurements.
Thirty-eight patients (13 persistent and 25 long-standing persistent AF) were enrolled with a mean AF duration of 33 ± 32.9 months. The procedure was successfully completed in 35 patients; 3 patients underwent only the surgical part because of a postoperative left atrial appendage thrombus (2 patients) and perioperative stroke (1 patient). After 6 months, 30 (86%) patients were arrhythmia-free, whereas 80% were also off antiarrhythmics. After 1 year, 28 (82%) patients were arrhythmia-free, 79% were off anti-arrhythmics and 47% were off anticoagulation treatment. Four (10.5%) serious postoperative complications occurred, including 1 stroke, 1 right phrenic nerve palsy and 2 pneumothoraxes with a need for drainage. Significant improvements were observed in echocardiographic, functional and serological parameters.
Hybrid ablation is an effective treatment strategy for patients with persistent or long-standing persistent AF. Over 80% of patients were arrhythmia-free 1 year after the procedure. Sinus rhythm restoration was accompanied by improvements in functional, echocardiographic and serological markers.
心房颤动（AF）的杂交消融是一种很有前景的治疗策略；然而，关于其疗效和安全性的数据仍然有限。
纳入非阵发性AF患者。首先，进行胸腔镜下心外膜肺静脉及左心房后壁隔离（“盒状损伤”）；使用了一种新型单极/双极射频设备。此外，在此后纳入的12例患者中，对左心耳进行了封堵。2 - 3个月后进行电生理评估和导管消融，目的是验证或完成（如有需要）盒状损伤以及消融神经节丛和腔静脉三尖瓣峡部。使用1周和24小时动态心电图监测、重复超声心动图检查和实验室测量来评估结果。
纳入38例患者（13例持续性和25例长期持续性AF），平均AF持续时间为33±32.9个月。35例患者成功完成手术；3例患者因术后左心耳血栓（2例）和围手术期卒中（1例）仅接受了手术部分。6个月后，30例（86%）患者无心律失常，80%的患者也停用了抗心律失常药物。1年后，28例（82%）患者无心律失常，79%的患者停用抗心律失常药物，47%的患者停用抗凝治疗。发生了4例（10.5%）严重术后并发症，包括1例卒中、1例右侧膈神经麻痹和2例需要引流的气胸。超声心动图、功能和血清学参数有显著改善。
杂交消融是持续性或长期持续性AF患者的一种有效治疗策略。术后1年超过80%的患者无心律失常。窦性心律恢复伴随着功能、超声心动图和血清学指标的改善。
