Kim Jae Hyun, Jang Woo Sung, Kim Jae-Bum, Lee Sook Jin
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
Department of Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea.
J Thorac Dis. 2019 Jan;11(1):84-92. doi: 10.21037/jtd.2018.12.118.
An enlarged left atrium (LA) is a well-known risk factor for ablation failure of atrial fibrillation (AF). We analyzed the result of concomitant AF ablation in patients with a giant LA and evaluated the effect of LA volume reduction.
Between 2000 and 2011, 116 patients with a giant LA (antero-posterior dimension ≥70 mm) who underwent surgical AF ablation during MV surgery were retrospectively reviewed. Among these, 28 patients received aggressive LA volume reduction procedure (reduction group) while the other 88 patients received the surgery without LA volume reduction (non-reduction group). Mean follow-up duration was 6.8±3.0 years.
Aortic clamping and cardio-pulmonary bypass times were significantly longer in reduction group than non-reduction group (P<0.001 and 0.025, respectively). There were no significant differences in early mortality rates (3.7% 5.7%, P>0.99) and major complication rates. Rates of freedom from AF at 1, 3 and 5 years were 84.2%, 74.3% and 54.5%, respectively in reduction group and 49.0%, 33.2% and 28.4%, respectively in non-reduction group (P=0.013). Multivariable analysis revealed severe pulmonary hypertension as an independent risk factor for AF recurrence (HR, 15.9; 95% CI, 1.69-149.54, P=0.015) while LA volume reduction (HR, 0.50; 95% CI, 0.28-0.89, P=0.018) and the use of cryoablation instead of radiofrequency (HR, 0.11; 95% CI, 0.01-0.95, P=0.045) were found to be protective against AF recurrence.
Aggressive LA volume reduction was found to improve rhythm outcomes in patients with a giant LA undergoing surgical AF ablation.
左心房（LA）增大是心房颤动（AF）消融失败的一个众所周知的危险因素。我们分析了巨大左心房患者同时进行房颤消融的结果，并评估了左心房容积减小的效果。
回顾性分析2000年至2011年间116例在二尖瓣手术期间接受外科房颤消融的巨大左心房（前后径≥70mm）患者。其中，28例患者接受了积极的左心房容积减小手术（减容组），而其他88例患者接受了未进行左心房容积减小的手术（非减容组）。平均随访时间为6.8±3.0年。
减容组的主动脉阻断和体外循环时间显著长于非减容组（分别为P<0.001和0.025）。早期死亡率（3.7%对5.7%，P>0.99）和主要并发症发生率无显著差异。减容组1年、3年和5年的无房颤率分别为84.2%、74.3%和54.5%，非减容组分别为49.0%、33.2%和28.4%（P=0.013）。多变量分析显示，严重肺动脉高压是房颤复发的独立危险因素（HR，15.9；95%CI，1.69-149.54，P=0.015），而左心房容积减小（HR，0.50；95%CI，0.28-0.89，P=0.018）和使用冷冻消融而非射频消融（HR，0.11；95%CI，0.01-0.95，P=0.045）被发现可预防房颤复发。
对于接受外科房颤消融的巨大左心房患者，积极的左心房容积减小可改善节律结局。
