Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Department of Cardiac Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Eur J Cardiothorac Surg. 2021 Oct 22;60(4):850-856. doi: 10.1093/ejcts/ezab138.
Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years.
Fifty consecutive patients {mean age 55 [standard deviation (SD): 11.2] years, previous catheter ablation in 56%, left ventricular ejection fraction 60% (SD: 4.6), left atrium volume 65 ml (SD: 17)} with stand-alone symptomatic paroxysmal AF underwent PVI through bilateral thoracoscopy ablation between 2005 and 2014. The CHA2DS2-VASc score was ≥2 in 12 patients (24%).
No hospital deaths occurred. At hospital discharge all patients but 1 (2%) were in sinus rhythm (SR). Follow-up was 100% complete [mean 8.4 years (SD: 2.3), max 15]. The 8-year cumulative incidence function of AF recurrence, with death as a competing risk, on or off class I/III antiarrhythmic drugs (AADs)/electrocardioversion/re-transcatheter ablation (TCA) was 20% (SD: 5; 95% confidence interval: 10, 32); and off class I/III AADs/electrocardioversion/re-TCA was 52% (SD: 7; 95% confidence interval: 0.83, 8.02). At 8 years, the predicted prevalence of patients in SR was 87% and 53% were off class I/III AADs/electrocardioversion/re-TCA. The recurrent arrhythmia was AF in all patients except 2, who had atypical atrial flutter (4%). No predictors of AF recurrence were identified. At the last follow-up, 76% of the patients showed European Heart Rhythm Association class I. No strokes or thromboembolic events were documented and 76% of the subjects were off anticoagulation therapy.
Despite a considerable AF recurrence rate, our single-centre, long-term outcome of surgical PVI showed encouraging data, with the majority of patients remaining in SR, although many of them were on antiarrhythmic therapy.
先前的系列研究表明,对于孤立性阵发性心房颤动(房颤)患者,进行胸腔镜消融术治疗后,7 年的随访结果良好。本研究旨在评估手术肺静脉隔离(PVI)的长期疗效,随访时间超过 7 年。
2005 年至 2014 年,50 例孤立性阵发性房颤症状患者(平均年龄 55 [标准差(SD):11.2] 岁,56%曾行导管消融术,左心室射血分数 60%(SD:4.6),左心房容积 65ml(SD:17))接受双侧胸腔镜消融术进行 PVI。12 例患者(24%)的 CHA2DS2-VASc 评分≥2。
无院内死亡病例。出院时,除 1 例(2%)患者外,其余患者均为窦性心律(SR)。随访率为 100%(平均 8.4 年(SD:2.3),最长 15 年)。以死亡为竞争风险,在服用或不服用 I 类/III 类抗心律失常药物(AAD)/电复律/再次导管消融(TCA)的情况下,房颤复发的 8 年累积发生率函数为 20%(SD:5;95%置信区间:10,32);不服用 I 类/III 类 AAD/电复律/再次 TCA 的复发率为 52%(SD:7;95%置信区间:0.83,8.02)。8 年后,SR 患者的预计患病率为 87%,不服用 I 类/III 类 AAD/电复律/再次 TCA 的患者比例为 53%。除 2 例患者(4%)为非典型性房性心动过速外,其余患者的复发性心律失常均为房颤。未发现房颤复发的预测因素。最后一次随访时,76%的患者达到欧洲心脏病学会心律协会 I 级。无卒中和血栓栓塞事件发生,76%的患者停止抗凝治疗。
尽管房颤复发率较高,但本单中心、长期研究结果显示,手术 PVI 具有令人鼓舞的疗效,大多数患者仍保持窦性心律,但其中许多患者仍在服用抗心律失常药物。