Hodges Kevin, Tang Andrew, Rivas Carlos G, Umana-Pizano Juan, Chemtob Raphaelle, Desai Milind Y, Gillinov A M, Smedira Nicholas, Wierup Per
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiology, University of Connecticut/Hartford Hospital, Hartford, Connecticut.
J Card Surg. 2020 Nov;35(11):2957-2964. doi: 10.1111/jocs.14946. Epub 2020 Aug 16.
To assess outcomes of concomitant ablation for atrial fibrillation (AF) in patients with preoperative AF undergoing septal myectomy for hypertrophic obstructive cardiomyopathy.
From 2005 to 2016, 67 patients underwent concomitant ablation for AF and septal myectomy and had a follow-up beyond a 3-month blanking period. Ablation strategy (pulmonary vein isolation [PVI], modified Cox-maze III [CM-III], or Cox-maze IV [CM-IV]) was tailored to preoperative AF burden, with high AF burden defined as persistent AF or need for cardioversion. AF recurrence was analyzed as a time-related event and predictors of recurrence identified using a random forest methodology.
A total of 38 patients (57%) had low AF burden and 29 (43%) high burden. Patients with low AF burden most frequently underwent PVI (68%). Patients with high AF burden more frequently underwent CM-III (62%) or CM-IV (35%). Besides the preoperative AF burden, baseline characteristics were similar between patients receiving CM-III, CM-IV, and PVI. After surgery, the maximum provoked left ventricular outflow tract (LVOT) gradient decreased from 99 ± 34 to 18 ± 11mm Hg (P < .001). Eight patients (12%) required a permanent pacemaker. Cumulative AF recurrence at 1, 2, and 5 years was 11%, 22%, and 48%, respectively. Age, low preoperative resting LVOT gradient, and large left atrial diameter were predictors of AF recurrence.
Surgical outcomes of concomitant ablation for AF and septal myectomy are good, although recurrence of AF by 5 years is frequent.
评估肥厚性梗阻性心肌病患者在接受室间隔心肌切除术前伴有心房颤动（AF）时同期行房颤消融术的疗效。
2005年至2016年，67例患者同期接受了房颤消融术和室间隔心肌切除术，并在3个月的空白期后进行了随访。消融策略（肺静脉隔离[PVI]、改良考克斯迷宫III型[CM-III]或考克斯迷宫IV型[CM-IV]）根据术前房颤负荷进行调整，高房颤负荷定义为持续性房颤或需要心脏复律。将房颤复发作为一个与时间相关的事件进行分析，并使用随机森林方法确定复发的预测因素。
共有38例患者（57%）房颤负荷低，29例（43%）房颤负荷高。房颤负荷低的患者最常接受PVI（68%）。房颤负荷高的患者更常接受CM-III（62%）或CM-IV（35%）。除术前房颤负荷外，接受CM-III、CM-IV和PVI的患者基线特征相似。术后，最大诱发左心室流出道（LVOT）梯度从99±34降至18±11mmHg（P<0.001）。8例患者（12%）需要植入永久起搏器。1年、2年和5年时房颤累积复发率分别为11%、22%和48%。年龄、术前静息LVOT梯度低和左心房直径大是房颤复发的预测因素。
房颤消融术和室间隔心肌切除术同期手术效果良好，尽管5年时房颤复发很常见。
