Churyla Andrei, Desai Anand, Kruse Jane, Cox James, McCarthy Patrick
Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois.
J Cardiovasc Electrophysiol. 2020 Aug;31(8):2172-2178. doi: 10.1111/jce.14408. Epub 2020 Mar 10.
Surgical ablation of atrial fibrillation (AF) in conjunction with other cardiac surgery is now a class I guideline recommendation. Multiple studies have demonstrated that the concomitant surgical ablation of AF can be performed safely and effectively during valve and coronary artery bypass grafting (CABG) resulting in a return to sinus rhythm postoperatively and improved long-term results. However, the surgical ablation of AF at the time of other cardiac surgery is performed less often than it should be, especially in patients undergoing CABG and aortic valve surgery. Randomized-controlled trials designed to determine the effect of treating AF concomitantly with other cardiac surgical procedures have lacked long-term follow up, but multiple, large observational studies have demonstrated an improved quality of life, a decrease in long-term strokes, and improved late survival in patients who undergo AF ablation. However, the potential survival benefit of concomitant AF ablation was not addressed by either the Society of Thoracic Surgery or American Association for Thoracic Surgery guideline committees. Left atrial appendage closure is an important part of the surgical ablation of AF as it significantly reduces the long-term risk of stroke following cardiac surgery and improves the success of AF treatment. In this study, we update the electrophysiology and surgical community on the recommended surgical techniques for AF ablation and its effect on perioperative morbidity, perioperative mortality, as well as its long-term effects on stroke, quality of life, and survival.
房颤（AF）的外科消融术与其他心脏手术联合进行目前是I类指南推荐。多项研究表明，在瓣膜手术和冠状动脉旁路移植术（CABG）期间可以安全有效地同时进行房颤的外科消融，从而使患者术后恢复窦性心律并改善长期效果。然而，在其他心脏手术时进行房颤的外科消融术的频率低于应有的水平，尤其是在接受CABG和主动脉瓣手术的患者中。旨在确定在其他心脏手术过程中同时治疗房颤效果的随机对照试验缺乏长期随访，但多项大型观察性研究表明，接受房颤消融术的患者生活质量得到改善，长期中风发生率降低，晚期生存率提高。然而，胸外科医师协会或美国胸外科协会指南委员会均未探讨同时进行房颤消融术可能带来的生存益处。左心耳封堵是房颤外科消融的重要组成部分，因为它可显著降低心脏手术后长期中风的风险，并提高房颤治疗的成功率。在本研究中，我们向电生理学界和外科界介绍了房颤消融推荐手术技术及其对围手术期发病率、围手术期死亡率的影响，以及其对中风、生活质量和生存的长期影响。
