Concomitant atrial fibrillation ablation in patients undergoing coronary artery bypass and cardiac valve surgery
Concomitant atrial fibrillation ablation in patients undergoing coronary artery bypass and cardiac valve surgery
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DOI：
10.1111/jce.14408
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发表时间：
2020-08-01
影响因子：
2.7
通讯作者：
McCarthy, Patrick
中科院分区：
文献类型：
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作者：
Churyla, Andrei;Desai, Anand;McCarthy, Patrick
房颤（AF）的外科消融术联合其他心脏手术现在是I类指南推荐。多项研究表明，在瓣膜和冠状动脉旁路移植术（CABG）期间可以安全有效地进行AF的伴随手术消融，术后恢复窦性心律并改善长期结果。然而，在其他心脏手术时进行AF的外科消融术的频率低于应有的频率，特别是在接受CABG和主动脉瓣手术的患者中。设计用于确定与其他心脏外科手术同时治疗AF的效果的随机对照试验缺乏长期随访，但多项大型观察性研究表明，接受AF消融术的患者生活质量得到改善，长期卒中减少，晚期生存率提高。然而，胸外科学会或美国胸外科协会指南委员会均未讨论伴随房颤消融的潜在生存获益。左心耳封堵术是房颤外科消融术的重要组成部分，因为它可显著降低心脏手术后卒中的长期风险，并提高房颤治疗的成功率。在这项研究中，我们更新了电生理学和外科界推荐的房颤消融术手术技术及其对围手术期发病率、围手术期死亡率的影响，以及对卒中、生活质量和生存率的长期影响。
Surgical ablation of atrial fibrillation (AF) in conjunction with other cardiac surgery is now a class I guideline recommendation. Multiple studies have demonstrated that the concomitant surgical ablation of AF can be performed safely and effectively during valve and coronary artery bypass grafting (CABG) resulting in a return to sinus rhythm postoperatively and improved long-term results. However, the surgical ablation of AF at the time of other cardiac surgery is performed less often than it should be, especially in patients undergoing CABG and aortic valve surgery. Randomized-controlled trials designed to determine the effect of treating AF concomitantly with other cardiac surgical procedures have lacked long-term follow up, but multiple, large observational studies have demonstrated an improved quality of life, a decrease in long-term strokes, and improved late survival in patients who undergo AF ablation. However, the potential survival benefit of concomitant AF ablation was not addressed by either the Society of Thoracic Surgery or American Association for Thoracic Surgery guideline committees. Left atrial appendage closure is an important part of the surgical ablation of AF as it significantly reduces the long-term risk of stroke following cardiac surgery and improves the success of AF treatment. In this study, we update the electrophysiology and surgical community on the recommended surgical techniques for AF ablation and its effect on perioperative morbidity, perioperative mortality, as well as its long-term effects on stroke, quality of life, and survival.