Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany.
Medicina (Kaunas). 2022 Nov 7;58(11):1607. doi: 10.3390/medicina58111607.
: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in those patients. We investigated the outcome of patients with isolated pulmonary vein isolation compared to those receiving an extended left atrial (LA) lesion set. : Between 2003 and 2016, 817 patients received concomitant surgical AF ablation in our institution. A total of 268 patients with paroxysmal AF were treated by surgical ablation concomitant to AVR or CABG. Of those, 86 patients underwent a complete left-sided lesion set, while 182 patients were treated with an isolated pulmonary vein isolation. The primary endpoint was freedom from atrial fibrillation at 12 months' follow-up. There were no statistically significant differences regarding baseline characteristics. No major ablation-related complications were observed in any of the groups. In the PVI group, three patients (1.6%) had an intraoperative stroke, while two (2.3%) patients experienced a stroke in the LA ablation group ( = 0.98). In-hospital mortality was 3.4% in the PVI group, and 2.8% in the extended LA group ( = 0.33). Freedom from AF at 12 months' follow-up was 76% in the extended LA ablation group and 70% in the PVI group, showing no statistically significant difference ( = 0.32). Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is safe and effective. There was no statistically significant difference between the compared lesion sets in terms of freedom from AF, survival or stroke rate after 12 months.
在接受冠状动脉旁路移植术（CABG）或主动脉瓣手术的阵发性心房颤动（AF）患者中，许多外科医生不愿意打开左心房进行完整的左侧 Cox-Maze 病变消融。在这些患者中，肺静脉隔离（PVI）通常更受欢迎。我们研究了与接受扩展左心房（LA）病变消融的患者相比，接受单纯肺静脉隔离的患者的结果。
在 2003 年至 2016 年间，我院共有 817 例患者同时接受了外科房颤消融治疗。共有 268 例阵发性 AF 患者接受了同时进行的 AV 或 CABG 手术消融。其中 86 例患者接受了完整的左侧病变消融，182 例患者接受了单纯肺静脉隔离。主要终点是 12 个月随访时无房颤。
两组患者的基线特征无统计学差异。任何一组均未观察到与消融相关的重大并发症。在 PVI 组中，3 例（1.6%）患者术中发生中风，而 LA 消融组中 2 例（2.3%）患者发生中风（=0.98）。PVI 组住院死亡率为 3.4%，LA 组为 2.8%（=0.33）。LA 消融组 12 个月时无 AF 发生率为 76%，PVI 组为 70%，差异无统计学意义（=0.32）。
在阵发性 AF 患者中，同时进行 CABG 或 AVR 的外科房颤消融是安全有效的。在 12 个月时，两种消融方式在无 AF、生存率或中风发生率方面无统计学差异。
