Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Ann Thorac Cardiovasc Surg. 2022 Oct 20;28(5):349-358. doi: 10.5761/atcs.oa.22-00033. Epub 2022 Jul 6.
We aimed to compare the efficacy of radiofrequency ablation (RFA) in patients undergoing mitral valve (MV) surgery with or without giant left atria.
This retrospective, single-center, cohort study investigated patients who underwent MV surgery and concomitant RFA from 2009 to 2019. Patients were divided into non-giant left atria (diameter ≤65 mm, n = 1543) and giant left atria (diameter >65 mm, n = 241) groups. Five-year freedom from atrial tachyarrhythmia recurrence and thromboembolic event (TE) rates were assessed with death as the competing risk factor with and without propensity-score matching.
Patients with giant left atria had higher mortality (10.8% versus 6.2%, P = 0.008) and readmission rates for heart failure than those without (12.0% versus 6.8%, P = 0.004). Atrial tachyarrhythmia recurrence rates were higher in patients with giant left atria than in those without (49% versus 24% at 5 years, P <0.001), but the cumulative incidence of TEs before (P = 0.944) and after (P = 0.695) propensity-score matching was comparable.
RFA effectively prevented TEs in patients with giant left atria, despite significant atrial tachyarrhythmia recurrence. Atrial tachyarrhythmia recurrence did not increase the risk of TEs. A lower success rate should be considered when deciding whether to perform surgical ablation in patients with giant left atria.
本研究旨在比较合并或不合并巨大左心房的二尖瓣（MV）手术患者射频消融（RFA）的疗效。
这是一项回顾性、单中心、队列研究，纳入了 2009 年至 2019 年期间行 MV 手术并同期行 RFA 的患者。患者分为非巨大左心房（直径≤65mm，n=1543）和巨大左心房（直径＞65mm，n=241）组。采用竞争风险因素（以死亡为竞争风险因素）评估 5 年无房性快速性心律失常（房速）复发和血栓栓塞事件（TE）的发生率，同时进行倾向评分匹配。
与无巨大左心房组相比，巨大左心房组患者死亡率（10.8% vs. 6.2%，P=0.008）和心力衰竭再入院率（12.0% vs. 6.8%，P=0.004）更高。巨大左心房组患者房速复发率高于无巨大左心房组（5 年时 49% vs. 24%，P＜0.001），但倾向评分匹配前后（P=0.944）TE 的累积发生率无差异（P=0.695）。
尽管巨大左心房患者房速复发率较高，但 RFA 可有效预防 TE。房速复发不会增加 TE 的风险。在决定是否对巨大左心房患者进行手术消融时，应考虑较低的成功率。
