Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
J Interv Card Electrophysiol. 2022 Aug;64(2):469-478. doi: 10.1007/s10840-021-01056-1. Epub 2021 Sep 16.
Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA.
Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m. Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up.
At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4-62.8] ml/m), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2-41.3] ml/m). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8-49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8-47.4 in a combined group of GLA and/or female sex(log rank p = 0.02).
Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.
随着左心房（LA）容积的增加，肺静脉隔离（PVI）治疗心房颤动（AF）的疗效降低。然而，对于左心房巨大（GLA）的患者，正在进行疗效未知的外科 AF 消融术。我们确定了与非 GLA 患者相比，胸腔镜 AF 消融术的疗效。
患者接受胸腔镜 PVI 治疗，并进行额外的左心房消融线（持续性 AF 时），前瞻性随访。GLA 定义为左心房容积指数（LAVI）≥50ml/m。每 3 个月通过心电图和 24 小时动态心电图进行随访。经过 3 个月的空白期后，所有抗心律失常药物均停用。主要结局是在 2 年的随访期间，任何持续≥30 秒的房性快速心律失常的无发作率。
基线时，68 例（15.4%）患者有 GLA（LAVI：56.7[52.4-62.8]ml/m），而 374 例（84.6%）患者左心房较小（LAVI：34.8[29.2-41.3]ml/m）。GLA 患者年龄较大（61.9±6.9 岁比 59.4±8.8 岁，p=0.02），持续性 AF 诊断率较高（76.5%比 58.6%，p=0.008）。性别分布均匀（约 25%为女性）。与非 GLA 患者相比，GLA 患者在 2 年随访时的复发率更高（42.6%比 57.2%，对数秩检验 p=0.02）。非 GLA 阵发性 AF 患者的 AF 无发作率为 69.0%，而 GLA 和/或持续性 AF 患者的综合组为 43.8%-49.3%（对数秩检验 p<0.001）。此外，非 GLA 男性患者的无发作率为 62.4%，而 GLA 和/或女性的综合组为 43.8%-47.4%（对数秩检验 p=0.02）。
胸腔镜 AF 消融术是 GLA 患者的一种有效治疗方法。胸腔镜 AF 消融术可能是这些患者的最后治疗选择。
