Division of Cardiology, University of Florida, Gainesville, Florida.
Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida.
J Cardiovasc Electrophysiol. 2019 Aug;30(8):1297-1303. doi: 10.1111/jce.13970. Epub 2019 Jun 20.
Inappropriate sinus tachycardia (IST) is characterized by increased heart rate out of proportion to normal physiologic demand. IST ablation is challenging for the electrophysiology community due to the epicardial location of the sinus node and the risk of phrenic nerve (PN) injury during catheter ablation. In this study, we investigated the safety and efficacy of a minimally invasive thoracoscopic surgery for elimination of IST.
Patients with IST who failed medical therapy or endocardial ablation underwent minimally invasive thoracoscopic epicardial ablation. Epicardial activation mapping was performed to identify the earliest activation site and any possible migration of earliest activation along the lateral right atrium. The PN in each patient was protected by a pericardial retraction suture.
From 1 January 2000 to 15 June 2018, 10 patients (eight females and two males) underwent minimally invasive thoracoscopic IST ablation. Mean age of the patients was 36.7 ± 12.5 years. Mean baseline sinus rate was 113.8 ± 21.8 beats per minute. After surgery, the mean heart rate significantly decreased to 79.8 ± 8.2 at postoperative day 1 and to 75.8 ± 8.1 at day 30 (both P < .001). No in-hospital death, stroke, or PN injury occurred. One patient required reintubation, one patient developed postoperative pericarditis, and another patient had a pulmonary embolus. Median follow-up was 6 months (range, 1-50). Freedom from reintervention was 88% at 6 months.
Minimally invasive thoracoscopic ablation for IST is a safe and effective approach that preserves the phrenic nerve. Due to the possibility of IST activation site migration, continued follow-up after surgery is required.
不适当窦性心动过速（IST）的特征是心率增加与正常生理需求不成比例。由于窦房结的心脏外膜位置以及导管消融过程中膈神经（PN）损伤的风险，IST 消融对电生理学界来说具有挑战性。在这项研究中，我们研究了微创胸腔镜手术消除 IST 的安全性和有效性。
接受 IST 药物治疗或心内膜消融治疗失败的患者接受微创胸腔镜心外膜消融。进行心外膜激活映射以确定最早的激活部位和沿右侧心房外侧的任何可能的最早激活的迁移。每位患者的 PN 均由心包牵引缝线保护。
从 2000 年 1 月 1 日至 2018 年 6 月 15 日，10 名患者（8 名女性和 2 名男性）接受了微创胸腔镜 IST 消融治疗。患者的平均年龄为 36.7±12.5 岁。平均基础窦性率为 113.8±21.8 次/分钟。手术后，平均心率在术后第 1 天显著下降至 79.8±8.2，在第 30 天下降至 75.8±8.1（均 P<.001）。无院内死亡、中风或 PN 损伤。1 例患者需要重新插管，1 例患者发生术后心包炎，另 1 例患者发生肺栓塞。中位随访时间为 6 个月（范围 1-50）。6 个月时无再干预的成功率为 88%。
微创胸腔镜 IST 消融术是一种安全有效的方法，可以保留膈神经。由于 IST 激活部位可能发生迁移，因此术后需要继续随访。
