Kurfirst Vojtech, Csanady Julia, Mokracek Ales, Hanis Jiri, Bulava Alan, Pesl Ladislav
Department of Cardiac and Thoracic Surgery, Hospital of České Budějovice, České Budějovice, Czech Republic.
Kardiochir Torakochirurgia Pol. 2020 Mar;17(1):29-32. doi: 10.5114/kitp.2020.94188. Epub 2020 Apr 7.
Cryoenergy is the most commonly used method of lesion formation in patients who have undergone surgical ablation of atrial fibrillation. Despite frequent use, the clinical effect of cryoenergy in endocardial and epicardial approaches is unknown.
To compare the effect of various cryoenergy applications on the postoperative incidence of sinus rhythm and completeness of lesions performed.
A total of 55 patients underwent concomitant atrial fibrillation surgical ablation using cryoenergy under various conditions: epicardially during cardiac arrest, epicardially on beating heart, and endocardially. In the postoperative period, patients were invited to attend an electrophysiological examination to assess the completeness of surgical ablation lesions and, if necessary, to complete catheter ablation.
Twenty-four patients underwent epicardial ablation on the arrested heart (group 1), 12 patients underwent epicardial ablation on the beating heart (group 2), and 19 patients underwent endocardial ablation (group 3). In the electrophysiological examination, sinus rhythm was present in 71% vs. 83% vs. 89% of patients, respectively. The completeness of pulmonary vein isolation was confirmed in 31% vs. 25% vs. 95% of patients, complete box lesions in 15% vs. 0% vs. 79% of patients, respectively.
Despite the similar clinical effect of surgical ablation in all three approaches, the morphologically most effective use of cryoenergy is endocardial ablation. This approach has a very good result. Our findings further support the endocardial use of cryoenergy during surgical ablation of atrial fibrillation.
冷冻能量是房颤外科消融患者中最常用的形成病灶的方法。尽管使用频繁，但冷冻能量在心内膜和心外膜消融方法中的临床效果尚不清楚。
比较不同冷冻能量应用对术后窦性心律发生率和病灶完整性的影响。
共有55例患者在不同条件下使用冷冻能量进行房颤同期外科消融：心脏停搏下心外膜消融、心脏跳动下心外膜消融和心内膜消融。术后，邀请患者参加电生理检查，以评估外科消融病灶的完整性，必要时完成导管消融。
24例患者在心脏停搏下心外膜消融（第1组），12例患者在心脏跳动下心外膜消融（第2组），19例患者心内膜消融（第3组）。在电生理检查中，窦性心律分别出现在71%、83%和89%的患者中。肺静脉隔离的完整性在31%、25%和95%的患者中得到证实，完全盒状病灶分别在15%、0%和79%的患者中得到证实。
尽管三种消融方法的外科消融临床效果相似，但冷冻能量在形态学上最有效的应用是心内膜消融。这种方法效果非常好。我们的研究结果进一步支持在房颤外科消融期间心内膜使用冷冻能量。
