Li Xiangyu, Li Mingfang, Shao Yongfeng, Gu Weidong, Ni Buqing, Gu Jiaxi, Chen Minglong
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Division of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China.
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Thorac Cardiovasc Surg. 2023 Apr;165(4):1387-1394. doi: 10.1016/j.jtcvs.2021.03.114. Epub 2021 Apr 19.
The study objective was to determine whether mini-invasive transthoracoscopic atrial fibrillation ablation can delay the progression of atrial fibrillation from paroxysmal to persistent.
Patients aged 18 to 80 years with paroxysmal nonvalvular atrial fibrillation and a history of stroke or systemic thromboembolism were consecutively enrolled from September 2014 to June 2019. In the treatment group, patients underwent transthoracoscopic atrial fibrillation ablation plus left atrial appendage excision (atrial fibrillation ablation plus left atrial appendage excision group). Patients unwilling to receive surgical intervention were treated with antiarrhythmic drugs and oral anticoagulants and recruited as a control group (atrial fibrillation plus antiarrhythmic drugs group). The primary end point was the progression of atrial fibrillation from paroxysmal to persistent.
This study included 49 patients in the atrial fibrillation plus antiarrhythmic drugs group (29 men) and 77 patients in the atrial fibrillation ablation plus left atrial appendage excision group (48 men). In the atrial fibrillation ablation plus left atrial appendage excision group, after a median follow-up of 951 days (interquartile range, 529-1366 days), 8 patients (10.4%) progressed to persistent atrial fibrillation. In the atrial fibrillation plus antiarrhythmic drugs group, after a median follow-up of 835 days (interquartile range, 548-1214 days), 14 patients (28.6%) progressed to persistent atrial fibrillation. The atrial fibrillation ablation plus left atrial appendage excision group had a significantly lower incidence of atrial fibrillation progression than the atrial fibrillation plus antiarrhythmic drugs group during follow-up (3.9 vs 12.3 per 100 person-years, log-rank 8.6, P = .003).
Patients with paroxysmal nonvalvular atrial fibrillation who chose to undergo transthoracoscopic atrial fibrillation ablation had a lower incidence of progression to persistent atrial fibrillation than patients who chose conservative therapy. This strategy might be especially suitable for patients with paroxysmal nonvalvular atrial fibrillation at high risk of stroke and high risk of bleeding.
本研究的目的是确定微创经胸镜房颤消融术是否能延缓房颤从阵发性向持续性进展。
2014年9月至2019年6月，连续纳入年龄在18至80岁之间、患有阵发性非瓣膜性房颤且有中风或全身性血栓栓塞病史的患者。治疗组患者接受经胸镜房颤消融术加左心耳切除术（房颤消融术加左心耳切除术组）。不愿接受手术干预的患者接受抗心律失常药物和口服抗凝剂治疗，并被招募为对照组（房颤加抗心律失常药物组）。主要终点是房颤从阵发性向持续性进展。
本研究包括房颤加抗心律失常药物组49例患者（男性29例）和房颤消融术加左心耳切除术组77例患者（男性48例）。在房颤消融术加左心耳切除术组，中位随访951天（四分位间距，529 - 1366天）后，8例患者（10.4%）进展为持续性房颤。在房颤加抗心律失常药物组，中位随访835天（四分位间距，548 - 1214天）后，14例患者（28.6%）进展为持续性房颤。随访期间，房颤消融术加左心耳切除术组房颤进展的发生率显著低于房颤加抗心律失常药物组（每100人年分别为3.9和12.3，对数秩检验8.6，P = 0.003）。
选择接受经胸镜房颤消融术的阵发性非瓣膜性房颤患者进展为持续性房颤的发生率低于选择保守治疗的患者。该策略可能特别适用于有中风高风险和出血高风险的阵发性非瓣膜性房颤患者。
