Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, California.
Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California.
Semin Thorac Cardiovasc Surg. 2023 Summer;35(2):277-286. doi: 10.1053/j.semtcvs.2022.03.003. Epub 2022 Mar 10.
Hybrid ablation combines thoracoscopic epicardial ablation with percutaneous catheter based endocardial ablation for the treatment of AF. The purpose of this study was to evaluate the safety and efficacy of hybrid ablation surgery for the treatment of atrial fibrillation (AF), and to compare outcomes of unilateral vs bilateral thoracoscopic epicardial ablation. Patients with documented AF who underwent hybrid ablation were followed post-operatively for major events. Major events were classified into 2 categories consisting of (1) safety, comprising all-cause mortality and major morbidities, and (2) efficacy, which included recurrence of atrial arrhythmia, cessation of antiarrhythmic drugs (AAD), and completeness of lesion set. A total of 84 consecutive patients were consented for hybrid ablation. Patients presented with an average AF duration of 85.9 months before hybrid ablation. 80 patients underwent successful thoracoscopic epicardial ablation. At 1-year, 87% (60/69) of patients were free from AF and 73% (50/69) were free from AF and off AAD. 63 patients completed both epicardial and endocardial hybrid ablation with posterior wall isolation achieved in 89% (56/63) of patients. Unilateral epicardial ablation was associated with significantly shorter hospital length of stay compared to bilateral surgical approached (3.9 vs 6.7 days, p = 0.002) with no difference in freedom from AF between groups at 1 year. Hybrid ablation for atrial fibrillation is effective for patients at high risk for recurrence after catheter ablation. The unilateral surgical approach may be associated with shorter hospital stay with no appreciable effect on procedure success rates.
杂交消融术结合了胸腔镜心外膜消融和经皮导管心内膜消融，用于治疗房颤。本研究旨在评估杂交消融术治疗心房颤动（房颤）的安全性和疗效，并比较单侧与双侧胸腔镜心外膜消融的结果。接受杂交消融术的有记录的房颤患者在术后接受主要事件的随访。主要事件分为两类，包括（1）安全性，包括全因死亡率和主要合并症，以及（2）疗效，包括房性心律失常复发、抗心律失常药物（AAD）停药和病变集的完整性。共有 84 例连续患者同意接受杂交消融术。患者在接受杂交消融术之前平均有 85.9 个月的房颤病史。80 例患者成功进行了胸腔镜心外膜消融术。在 1 年时，69%（60/69）的患者无房颤，73%（50/69）的患者无房颤且无 AAD。63 例患者完成了心外膜和心内膜杂交消融术，其中 89%（56/63）的患者实现了后间隔隔离。与双侧手术方法相比，单侧心外膜消融的住院时间明显缩短（3.9 天 vs 6.7 天，p=0.002），但两组在 1 年时的无房颤率无差异。对于导管消融后复发风险高的患者，房颤的杂交消融术是有效的。单侧手术方法可能与较短的住院时间相关，而对手术成功率没有明显影响。
