Ellis Christopher R, Badhwar Nitish, Tschopp David, Danter Matthew, Jackson Gregory G, Kerendi Faraz, Walters Tomas, Fang Qizhi, Deuse Tobias, Beygui Ramin, Lee Randall J
Division of Cardiology and Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Cardiology and Division of Cardiovascular Surgery, University of California, San Francisco, San Francisco, California, USA.
JACC Clin Electrophysiol. 2020 Dec 14;6(13):1603-1615. doi: 10.1016/j.jacep.2020.06.011. Epub 2020 Sep 16.
The aim of this study was to assess the safety and efficacy of a new subxiphoid hybrid epicardial-endocardial atrial fibrillation (AF) ablation and left atrial appendage (LAA) ligation approach for the treatment of persistent AF.
Surgical hybrid ablation procedures have shown promise for maintaining sinus rhythm versus catheter ablation but are associated with increased periprocedural adverse events.
Patients with symptomatic persistent AF (n = 33, mean age 64 ± 9 years, 25 men) who had antiarrhythmic drug therapy or prior catheter ablation was unsuccessful were referred for hybrid epicardial-endocardial AF ablation and LAA exclusion. LAA closure was confirmed by transesophageal echocardiographic Doppler flow and/or computed tomographic angiography 1 to 3 months post-ligation. The incidence of atrial tachycardia or AF recurrence, LAA closure, thromboembolic events, and post-operative complications were assessed.
All 33 patients underwent successful LAA ligation with epicardial ablation of the posterior left atrial wall, as well as endocardial pulmonary vein isolation and cavotricuspid isthmus ablation. Freedom from atrial tachycardia or AF was 91% (20 of 22 patients) at 6 months, 90% (18 of 20 patients) at 12 months, 92% (11 of 12 patients) at 18 months, and 92% (11 of 12) at 24 months. There were no acute periprocedural complications (<7 days). Thirty-day adverse events included 2 patients with pericardial effusion requiring pericardiocentesis and 1 incisional hernia repair. There were no long-term complications, strokes, or deaths. LAA ligation was complete in 27 of 33 subjects (82%), with 6 subjects having leaks of <5 mm.
Subxiphoid hybrid epicardial-endocardial ablation with LAA ligation is feasible, safe, and effective. Future prospective studies are needed to validate these initial findings.
本研究旨在评估一种新的剑突下经心外膜-心内膜联合心房颤动（AF）消融及左心耳（LAA）结扎方法治疗持续性AF的安全性和有效性。
与导管消融相比，外科杂交消融术在维持窦性心律方面显示出前景，但围手术期不良事件增加。
对有症状的持续性AF患者（n = 33，平均年龄64±9岁，25例男性）进行了研究，这些患者抗心律失常药物治疗或既往导管消融均失败，被转诊接受经心外膜-心内膜联合AF消融及LAA切除。在结扎后1至3个月通过经食管超声心动图多普勒血流和/或计算机断层血管造影确认LAA闭合。评估房性心动过速或AF复发、LAA闭合、血栓栓塞事件及术后并发症的发生率。
所有33例患者均成功进行了LAA结扎，同时进行了左心房后壁的心外膜消融、心内膜肺静脉隔离和三尖瓣峡部消融。6个月时无房性心动过速或AF的比例为91%（22例患者中的20例），12个月时为90%（20例患者中的18例），18个月时为92%（12例患者中的11例），24个月时为92%（12例中的11例）。围手术期无急性并发症（<7天）。30天不良事件包括2例心包积液需要心包穿刺和1例切口疝修补。无长期并发症、中风或死亡。33例受试者中有27例（82%）LAA结扎完全，6例受试者有<5mm的渗漏。
剑突下经心外膜-心内膜联合消融及LAA结扎是可行、安全且有效的。需要未来的前瞻性研究来验证这些初步发现。
