Department of Cardiac Surgery, University of Vienna, Vienna, Austria.
Department of Cardiac Surgery, University of Vienna, Vienna, Austria.
J Thorac Cardiovasc Surg. 2019 Jan;157(1):248-256. doi: 10.1016/j.jtcvs.2018.07.104. Epub 2018 Sep 25.
The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation.
In this pilot trial, 10 patients (6 male; mean age, 70 ± 10 years) with persistent atrial fibrillation were mapped preoperatively with a noninvasive surface system (ECVUE, CardioInsight, Medtronic Inc, Minneapolis, Minn). Eight patients were candidates for mitral valve surgery, 1 patient was a candidate for aortic valve and ascending aortic replacement, and 1 patient was a candidate for coronary bypass surgery. In 5 patients, tricuspid valve repair was also performed. The Cox-Maze III/IV was performed using combined cryoablation and bipolar radiofrequency, and the left appendage was removed in all cases. The median preprocedural duration of atrial fibrillation was 30 months, and the diameter of the left atrium was 63 mm. Atrial regions were divided according to the Bordeaux classification.
Preoperative mapping was successful in all patients with clear identification of the potential mechanism of atrial fibrillation. Biatrial pathology was recognized in all subjects. Rotor and macro re-entry activity were present in all patients, whereas focal activity was demonstrated in only 6 patients. Rotor activity in the right atrium was documented in all patients.
This is the first report on the preoperative use of the ECUVE in surgical candidates for concomitant surgical procedures. The fact that a biatrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Cox-Maze III/IV procedure to treat patients with valvular heart disease and nonparoxysmal atrial fibrillation. Preoperative mapping has the potential to significantly improve our understanding of the pathophysiology in atrial fibrillation and better guide the surgical ablation procedure of choice in a single patient.
本研究旨在使用一种非侵入性、逐搏、三维标测技术，研究持续性和长期持续性心房颤动患者同期手术消融的电生理机制。
在这项初步试验中，10 名患者（6 名男性；平均年龄 70±10 岁）在术前使用非侵入性表面系统（ECVUE、CardioInsight、Medtronic Inc、明尼苏达州明尼阿波利斯）进行了标测。8 名患者为二尖瓣手术候选者，1 名患者为主动脉瓣和升主动脉置换候选者，1 名患者为冠状动脉旁路手术候选者。在 5 名患者中，还进行了三尖瓣修复。Cox-Maze III/IV 采用冷冻消融和双极射频联合进行，所有病例均切除左心耳。术前心房颤动的中位时间为 30 个月，左心房直径为 63mm。心房区域根据波尔多分类进行划分。
所有患者均成功进行了术前标测，明确了心房颤动的潜在机制。所有受试者均发现双心房病变。所有患者均存在转子和大折返活动，而仅 6 例患者存在局灶活动。所有患者均记录到右心房转子活动。
这是首例报告在同期手术候选患者中使用 ECUVE 进行术前评估的研究。所有患者均检测到心房颤动的双心房机制，这强调了 Cox-Maze III/IV 手术治疗瓣膜性心脏病和非阵发性心房颤动患者的重要性。术前标测有可能显著提高我们对心房颤动病理生理学的理解，并更好地指导单一患者的手术消融程序。
