Kwon Hee-Jin, Jeong Dong Seop, Park Seung-Jung, Park Kyoung-Min, Kim June Soo, On Young Keun
Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol Heart Vasc. 2021 Aug 25;36:100861. doi: 10.1016/j.ijcha.2021.100861. eCollection 2021 Oct.
Totally thoracoscopic ablation (TTA) is a minimally invasive and safe alternative to radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF). It has evolved over the last decades, but data are limited. The aim of this study was to report the long-term efficacy and safety of TTA through a single center experience.
We retrospectively analyzed all consecutive patients who underwent TTA for AF from February 2012 to December 2018. All patients were followed every 3 months after operation with 12-lead ECG and 24-hour Holter ECG monitoring. The late recurrence of AF was defined as any atrial tachyarrhythmia (ATa) sustained more than 30 s from 3 months after surgery.
Of the total 408 patients undergoing TTA, 265 were analyzed in this study (17% paroxysmal, persistent or long standing persistent 83%, mean age 56 ± 9 years). During the mean follow-up duration 23 ± 18 months, ATa-free survival rate was 74%, 64%, 58%, 51% and 51% at 1,2,3,4 and 5 years, respectively. At the last follow-up, 75% of patients had sinus rhythm with or without additional intervention. The overall complication rate was 4.5% (12 events) and four patients (1.5%) had a stroke during follow-up.
TTA could be effective treatment option for AF. It had a very low risk of complication and could reduce stroke incidence. Further studies are needed to improve treatment strategy.
对于心房颤动（AF）患者，全胸腔镜消融术（TTA）是一种微创且安全的射频导管消融术（RFCA）替代方案。在过去几十年中它不断发展，但相关数据有限。本研究的目的是通过单中心经验报告TTA的长期疗效和安全性。
我们回顾性分析了2012年2月至2018年12月期间连续接受TTA治疗AF的所有患者。术后每3个月对所有患者进行12导联心电图和24小时动态心电图监测。房颤的晚期复发定义为术后3个月后持续超过30秒的任何房性快速心律失常（ATa）。
在总共408例行TTA的患者中，本研究分析了265例（阵发性17%，持续性或长期持续性83%，平均年龄56±9岁）。在平均随访23±18个月期间，1年、2年、3年、4年和5年时无ATa生存率分别为74%、64%、58%、51%和51%。在最后一次随访时，75%的患者有窦性心律，无论是否有额外干预。总体并发症发生率为4.5%（12例），4例患者（1.5%）在随访期间发生中风。
TTA可能是治疗AF的有效选择。其并发症风险非常低，可降低中风发生率。需要进一步研究以改进治疗策略。
