Kress David C, Erickson Lynn, Mengesha Tadele W, Krum David, Sra Jasbir
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI.
J Patient Cent Res Rev. 2020 Jul 27;7(3):227-238. doi: 10.17294/2330-0698.1744. eCollection 2020 Summer.
It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.
Patients with persistent AF (N=108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial flutter or AF was determined with ambulatory monitoring (n=22) or electrocardiogram analysis (n=86) at each follow-up visit. Recurrence mode was confirmed by electrophysiology study for those patients undergoing subsequent catheter ablation after hybrid ablation.
Patients were followed for a mean ± standard deviation of 25 ± 14 months. Of patients who had a recurrence, 53% (n=33) were in atrial flutter and 47% (n=29) were in AF. Of those who had a recurrence with atrial flutter, 14 received repeat ablation for either left (n=11) or left/right (n=3) atrial flutter and 3 received AF ablation. Half of ablations for atrial flutter recurrence following the hybrid procedure involved the mitral isthmus.
Atrial flutter accounts for about half of arrhythmia recurrences post-hybrid ablation. If catheter ablation of the mitral isthmus is considered during the hybrid procedure to prevent subsequent occurrence of perimitral flutter, bidirectional block must be performed to ensure a complete line of block.
心房颤动（AF）占心内膜导管消融术后心律失常复发的一半，这一观点已被广泛接受。一种心外膜 - 心内膜联合方法（杂交手术）已成为单纯心内膜消融治疗AF的替代方法，但杂交手术后的复发情况尚未得到充分描述。这项回顾性研究旨在描述持续性AF患者杂交消融后的复发情况。
108例持续性AF患者接受了心内膜和心外膜对左心房后壁的消融，采用导管消融和小切口正中开胸手术方法（杂交手术）。每次随访时，通过动态监测（n = 22）或心电图分析（n = 86）确定是否存在心房扑动或AF。对于杂交消融后接受后续导管消融的患者，通过电生理检查确认复发模式。
患者平均随访时间为25±14个月。复发患者中，53%（n = 33）为心房扑动，47%（n = 29）为AF。在心房扑动复发的患者中，14例因左房（n = 11）或左/右房（n = 3）房扑接受了再次消融，3例接受了AF消融。杂交手术后心房扑动复发消融中，一半涉及二尖瓣峡部。
心房扑动约占杂交消融后心律失常复发的一半。如果在杂交手术中考虑对二尖瓣峡部进行导管消融以预防后续二尖瓣周围扑动的发生，必须进行双向阻滞以确保完全阻滞线。
