Benvegnù Luciana, Cibin Giorgia, Perrone Fabiola, Tarzia Vincenzo, D'Onofrio Augusto, Luciani Giovanni Battista, Gerosa Gino, Onorati Francesco
Cardiac Surgery Unit, Ospedale Santa Chiara di Trento, 38122 Trento, Italy.
Cardiac Surgery Unit, Azienda Ospedale, Università di Padova, 35122 Padova, Italy.
J Cardiovasc Dev Dis. 2025 Jul 29;12(8):289. doi: 10.3390/jcdd12080289.
Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning.
心房颤动仍然是最常见的持续性心律失常，尤其在老年人群中，并且与中风、心力衰竭风险增加以及生活质量下降相关。虽然导管消融被广泛用于节律控制，但其在持续性和长期心房颤动中的疗效有限。在过去二十年中，微创外科手术策略已成为有效的替代方法，旨在复制迷宫手术的成功同时减少手术创伤。本综述批判性地总结了目前可用于治疗心房颤动的微创技术，包括小切口开胸消融、胸腔镜消融以及诸如融合手术等杂交手术。这些方法通过实现直接可视化、透壁损伤创建和左心耳切除，为持久恢复窦性心律提供了可能，与传统开放手术相比围手术期发病率更低。能量源的选择在损伤疗效和安全性方面起着关键作用。特别关注每种手术的技术步骤、患者选择标准以及左心耳封堵在预防中风中的作用。将心外膜手术消融与心内膜导管手术相结合的杂交策略，在难治性或长期心房颤动患者中已显示出令人鼓舞的结果。尽管学习曲线较陡，但微创技术在恢复时间、缩短住院时间和减少并发症方面具有显著优势。随着证据不断发展，这些方法代表了心房颤动外科治疗的一项关键进展，值得纳入当代治疗方案和多学科心脏团队规划中。
