Witkowska Anna, Suwalski Piotr
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Medical Postgraduate Education, Warsaw, Poland.
J Thorac Dis. 2021 Mar;13(3):2000-2009. doi: 10.21037/jtd-20-1876.
Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts' opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.
心房颤动（AF）仍然是最常见的心律失常，在发达国家和老龄化国家中其患病率不断上升。抗心律失常药物治疗效果不佳，且受其毒性限制。1987年由詹姆斯·考克斯开发的房颤外科消融术即迷宫手术非常有效，但由于其侵入性和复杂性未被广泛采用。1998年海萨盖尔进行的具有里程碑意义的研究开创了一种新的治疗方法，即经皮导管消融术，对于症状性阵发性房颤且对最佳药物治疗无效的患者，该方法仍然是I/A类适应证。然而，其对持续性房颤（PSAF）患者的疗效远不能令人满意。微创外科消融设备和技术的最新进展在PSAF治疗中显示出非常好的效果。当前指南在疗效范围内将外科消融与导管消融等同起来，表明对于持续性心律失常患者，两者都可被视为有效且安全的治疗选择。FAST试验7年随访证实了外科消融的更高疗效，导管消融组的复发率高达87%，而胸腔镜消融组为56%。2009年引入了一种由外科（心外膜）和电生理（心内膜）联合组成的房颤侵入性治疗新概念。最近专家的意见和已发表的数据表明，由外科消融和导管消融的计划组合构成的适当混合治疗可能会取得更好的效果。外科消融最宝贵的益处之一是有可能同时封堵左心耳。最近报道了用于关闭左心耳的新型心外膜夹子取得了良好效果，该夹子放置在一次性支架的展开环中。
