Gwag Hye Bin, Jeong Dong Seop, Hwang Jin Kyung, Park Seung-Jung, Park Kyoung-Min, Kim June Soo, On Young Keun
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Interact Cardiovasc Thorac Surg. 2019 Feb 1;28(2):177-182. doi: 10.1093/icvts/ivy236.
Unlike catheter ablation, little is known about the benefits of cavotricuspid isthmus (CTI) ablation in total thoracoscopic ablation (TTA) of atrial fibrillation (AF). This study aimed to investigate the incidence of recurrent atrial tachyarrhythmia (ATa) according to additional CTI ablation after TTA in patients with persistent AF.
Among 208 consecutive patients who underwent TTA for persistent AF at the Samsung Medical Center from February 2012 to January 2016, a total of 63 patients with CTI ablation and 91 patients without CTI ablation were included in the final analysis. CTI ablation was performed in patients who had long-standing AF or atrial flutter episodes during the admission period.
There was no difference in baseline characteristics between the CTI ablation and non-CTI ablation groups, except for a higher number of male patients in the CTI ablation group. The CTI ablation group showed a significantly higher survival rate free from recurrent ATa than that of the non-CTI ablation group at 5 years (52.5% vs 41.4%, P = 0.046). In the multivariable analysis, CTI ablation (hazard ratio 0.46, 95% confidence interval 0.217-0.971; P = 0.042) and left atrial volume index (hazard ratio 1.05, 95% confidence interval 1.029-1.070; P < 0.001) were significantly correlated with recurrent ATa.
Patients with CTI ablation showed a better survival rate free from recurrent ATa compared with the non-CTI ablation group. The additional CTI ablation may reduce recurrent ATa after TTA in patients with documented atrial flutter or long-standing AF.
与导管消融不同，关于在房颤（AF）全胸腔镜消融（TTA）中三尖瓣峡部（CTI）消融的益处知之甚少。本研究旨在调查持续性房颤患者在TTA后进行额外CTI消融时复发性房性快速心律失常（ATa）的发生率。
在2012年2月至2016年1月期间于三星医疗中心接受TTA治疗持续性房颤的208例连续患者中，最终分析纳入了63例进行CTI消融的患者和91例未进行CTI消融的患者。对入院期间有长期房颤或房扑发作的患者进行CTI消融。
CTI消融组和非CTI消融组的基线特征无差异，除了CTI消融组男性患者数量较多。CTI消融组在5年时无复发性ATa的生存率显著高于非CTI消融组（52.5%对41.4%，P = 0.046）。在多变量分析中，CTI消融（风险比0.46，95%置信区间0.217 - 0.971；P = 0.042）和左心房容积指数（风险比1.05，95%置信区间1.029 - 1.070；P < 0.001）与复发性ATa显著相关。
与非CTI消融组相比，进行CTI消融的患者无复发性ATa的生存率更高。额外的CTI消融可能会降低有记录的房扑或长期房颤患者TTA后复发性ATa的发生率。
