Minimally invasive surgical ablation of atrial fibrillation: The thoracoscopic box lesion approach
Minimally invasive surgical ablation of atrial fibrillation: The thoracoscopic box lesion approach
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DOI：
10.1007/s10840-007-9172-3
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发表时间：
2007-12-01
影响因子：
1.8
通讯作者：
Ebra, George
中科院分区：
文献类型：
--
作者：
Pruitt, J. Crayton;Lazzara, Robert R.;Ebra, George
背景心房颤动是最常见的心律失常，与发病率和死亡率的增加有关。它通常与结构性心脏病有关;然而，孤立性房颤并不罕见。潜在的，这些患者是理想的候选人为微创胸腔镜手术治疗房颤。方法从2003年8月至2006年2月，100耐药的症状性孤立性房颤患者进行胸腔镜下非体外循环闭胸心外膜消融使用FLEX 10 AFx微波消融系统（指南，印第安纳波利斯，IN，美国）。男性66例（66.0%），女性34例（34.0%），平均年龄60.9 ± 9.8岁（范围37-81）。房颤的平均持续时间为72.4 ± 79.5（范围6-480）个月。阵发性房颤64例（64.0%），持续性房颤11例（11.0%），永久性房颤25例（25.0%）。术后住院并发症极少。平均术后住院时间为3.4 ± 1.7天。累积随访时间为2，106.3（平均23.1）患者月，最长随访时间为39.8个月。晚期死亡3例（3.0%）。在9名患者（9.0%）中，胸腔镜箱形病变肺静脉隔离手术和随后的电生理干预失败，并进行了Cox-Maze手术。随访100%完成，42.0%（37/88）的患者窦性心律正常。2例患者（2.3%）发生短暂性脑缺血发作，2例（2.3%）发生脑血管意外。27例患者（30.7%）需要术后电生理干预。10例（11.4%）胺碘酮和48例（54.5%）香豆素在follow.Conclusion全胸腔镜手术消融治疗房颤是技术上可行的，并提出了最小的风险，病人。应用微波能量的临床结果不太令人满意，没有证实肺静脉的电隔离。此外，尚未实现房颤的长期缓解。
Background Atrial fibrillation is the most common cardiac rhythm disturbance and is associated with increased morbidity and mortality. It is often found in association with structural heart disease; however, lone atrial fibrillation is not uncommon. Potentially, these patients are ideal candidates for a minimally invasive thoracoscopic approach for the surgical treatment of atrial fibrillation.Methods From August 2003 through February 2006, 100 drug-resistant symptomatic patients with lone atrial fibrillation underwent thoracoscopic off-pump closed-chest epicardial ablation using the FLEX 10 AFx Microwave Ablation System (Guidant, Indianapolis, IN, USA). There were 66 men (66.0%) and 34 women (34.0%), with a mean age of 60.9 +/- 9.8 (range 37-81) years. Mean duration of atrial fibrillation was 72.4 +/- 79.5 (range 6-480) months. Sixty-four patients (64.0% had paroxysmal, 11 (11.0%) had persistent and 25 (25.0%) had permanent atrial fibrillation.Results There were no hospital deaths. Postoperative in-hospital complications were minimal. Mean postoperative length of stay was 3.4 +/- 1.7 days. Cumulative follow-up was 2,106.3 (mean 23.1) patient months, with a maximum follow-up of 39.8 months. There were three late deaths (3.0%). In nine patients (9.0%), the thoracoscopic box lesion pulmonary vein isolation operation and subsequent electrophysiological intervention failed, and a Cox-Maze operation was performed. Follow-up was 100% complete, with 42.0% (37 of 88) patients in normal sinus rhythm. Two patients (2.3%) experienced a transient ischemic attack and two (2.3%) a cerebral vascular accident. Twenty-seven patients (30.7%) required electrophysiological intervention post procedure. Ten patients (11.4%) were on amiodarone and 48 (54.5%) were on coumadin at follow-up.Conclusion Totally thoracoscopic surgical ablation for the treatment of atrial fibrillation is technically feasible and presents minimal risk to the patient. Clinical results with the application of microwave energy have been less than satisfactory, with no demonstrated electrical isolation of the pulmonary veins. Moreover, long-term relief from atrial fibrillation has not been achieved.