Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia; Cardiovascular Surgery, Washington Adventist Hospital, Takoma Park, Maryland; Inova Fairfax Hospital, Falls Church, Virginia.
Heart and Vascular Institute, West Virginia University Medicine, Morgantown, West Virginia.
Ann Thorac Surg. 2018 May;105(5):1370-1376. doi: 10.1016/j.athoracsur.2017.11.075. Epub 2018 Jan 8.
An important challenge in surgical ablation for atrial fibrillation (AF) is the scarcity of publications on credible predictors of long-term success in procedures performed with ablation tools that produce consistently reliable transmural lesions. We examined factors associated with 1-year success and no atrial arrhythmia (AA) recurrence during 1 to 5 years after surgical ablation for AF.
The study prospectively monitored 743 surgical ablation patients with complete rhythm follow-up at 12 months after the operation. No detected AA was defined as no known recurrence of AA, no cardioversions, and no catheter ablations at all available follow-up assessments.
Patients were a mean age of 64.7 years, and 32% were women. Patients with no detected AA during the first year after surgical ablation were more likely to maintain sinus rhythm without recurrence during 1 to 5 years (74% vs 28%, p < 0.001) and to be in sinus rhythm off medication at 5 years (80% vs 53%, p < 0.001). Mixed-model logistic regression revealed that lower risk for AA recurrence during 1 to 5 years was associated with no detected AA during the first 12 months (odds ratio [OR], 0.11; p < 0.001) and surgeon experience with 50 or more cases (OR, 0.63; p = 0.043), whereas older age (OR, 1.03; p < 0.001) and longer preoperative AF duration (OR, 1.04; p = 0.043) were associated with greater risk for AA recurrence.
Most patients with no detected AA throughout the first 12 months after surgical ablation continued to be recurrence free for 5 years. Younger age, shorter preoperative AF duration, and greater surgeon experience may be associated with more persistent surgical correction of AF.
在使用能够产生一致可靠的贯穿性损伤的消融工具进行房颤（AF）消融手术中，长期成功的可靠预测因子的相关出版物稀缺，这是一个重要的挑战。我们研究了与 AF 消融手术后 1 至 5 年内 1 年成功率和无房性心律失常（AA）复发相关的因素。
这项前瞻性研究对 743 例接受完全节律随访的手术消融患者进行了监测，在手术后 12 个月时进行。无检测到的 AA 定义为在所有可获得的随访评估中无已知的 AA 复发、无电复律和无导管消融。
患者的平均年龄为 64.7 岁，32%为女性。在手术消融后 1 年内未检测到 AA 的患者在 1 至 5 年内更有可能维持窦性节律而不复发（74%对 28%，p < 0.001），并且在 5 年内停用药物后维持窦性节律（80%对 53%，p < 0.001）。混合模型逻辑回归显示，在 1 至 5 年内 AA 复发风险较低与在最初 12 个月内未检测到 AA（比值比 [OR]，0.11；p < 0.001）和外科医生有 50 例或更多手术经验（OR，0.63；p = 0.043）相关，而年龄较大（OR，1.03；p < 0.001）和术前 AF 持续时间较长（OR，1.04；p = 0.043）与 AA 复发风险增加相关。
在手术消融后最初 12 个月内未检测到 AA 的大多数患者在 5 年内持续无复发。年龄较小、术前 AF 持续时间较短和外科医生经验较多可能与 AF 的持续手术矫正更相关。
