Rosati Fabrizio, Muneretto Claudio, Merati Elisa, Polvani Gianluca, Moltrasio Massimo, Tondo Claudio, Curnis Antonio, Cerini Manuel, Metras Alexandre, Bisleri Gianluigi
Innovations (Phila). 2018 Mar/Apr;13(2):114-119. doi: 10.1097/IMI.0000000000000482.
Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.
Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.
Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation.
Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.
尽管在过去十年中，用于孤立性房颤手术治疗的微创方法已越来越受欢迎，但消融技术和广泛的损伤范围在成功完成手术中起着重要作用，尤其是在持续性和长期持续性房颤患者中。我们评估了使用新型集成单极射频设备进行完全内镜下双房心外膜消融治疗持续性房颤后的临床结果。
49例连续的孤立性房颤患者接受了右侧单孔胸腔镜手术消融，采用新型集成单极射频能量传递和温度控制技术。49例患者中，13例（26.5%）为持续性房颤，36例（73.5%）为长期持续性房颤。平均年龄±标准差为60.6±10.3岁。房颤的中位持续时间为74个月。平均左心房直径±标准差为44.7±4.0mm。
通过微创方法成功完成了所有肺静脉的心外膜整块隔离（盒状损伤）以及右心房游离壁的额外消融，无任何术中及术后严重并发症。术中分别有77.5%（38/49）和91.8%（45/49）的患者实现了入口和出口阻滞。平均消融时间±标准差为16.3±4.8分钟。无需入住重症监护病房。93.8%（30/32）的患者术后恢复窦性心律，无需植入起搏器。在13个月时，87.7%（43/49）的患者处于窦性心律；71.4%（35/49）的患者无需使用抗心律失常药物，75.5%（37/49）的患者无需口服抗凝药。
集成单极射频消融技术经完全内镜方法显示对房颤手术治疗有效。具有广泛左右心房损伤范围的多功能吸引装置可能进一步改善非阵发性房颤患者的治疗效果。
