Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year
Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year
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DOI：
10.1093/icvts/ivx248
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Straka, Zbynek
中科院分区：
文献类型：
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作者：
Budera, Petr;Osmancik, Pavel;Straka, Zbynek
目的：混合消融心房颤动（AF）是一种很有前途的治疗策略，但是，关于其疗效和安全性的数据仍然limited.METHODS：非阵发性AF患者参加。首先，进行胸腔镜下肺静脉和左心房后壁（“箱形病变”）的心外膜隔离;使用新型单极/双极射频器械。此外，在此后入组的12例患者中，左心耳被闭塞。2-3个月后进行电生理评价和导管消融，目的是验证或完成（如需要）箱形损伤和神经节丛和三尖瓣环峡部消融。结果进行了评估，使用1周和24小时霍尔特监测，重复超声心动图和实验室measurements.Results：38例（13个持续性和25个长期持续性AF）入组，平均AF持续时间为33 +/- 32.9个月。35例患者成功完成手术; 3例患者因术后左心耳血栓（2例患者）和围手术期卒中（1例患者）仅接受手术部分。6个月后，30例（86%）患者无疟疾，而80%的患者也停止了抗疟疾治疗。1年后，28例（82%）患者无血小板减少，79%的患者停用抗血小板治疗，47%的患者停用抗凝治疗。发生4例（10.5%）严重术后并发症，包括1例卒中、1例右膈神经麻痹和2例气胸，需要引流。超声心动图，功能和血清学parameters.CONCLUSIONS：混合消融术是一种有效的治疗策略，为患者持续性或长期持续性AF。超过80%的患者无心绞痛1年后的程序。窦性心律恢复伴随着功能、超声心动图和血清学标志物的改善。
OBJECTIVES: Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy; however, data regarding its efficacy and safety are still limited.METHODS: Patients with non-paroxysmal AF were enrolled. First, a thoracoscopic, epicardial isolation of pulmonary veins and the left atrial posterior wall ('box lesion') was performed; a novel unipolar/bipolar radiofrequency device was used. Moreover, in 12 patients enrolled thereafter, the left atrial appendage was occluded. Electrophysiological evaluation and catheter ablation were performed 2-3 months later, with the goal of verifying or completing (if needed) the box lesion and ablation of the ganglionated plexi and the cavotricuspid isthmus. Outcomes were assessed using 1-week and 24-h Holter monitoring, repeated echocardiography and laboratory measurements.RESULTS: Thirty-eight patients (13 persistent and 25 long-standing persistent AF) were enrolled with a mean AF duration of 33 +/- 32.9 months. The procedure was successfully completed in 35 patients; 3 patients underwent only the surgical part because of a postoperative left atrial appendage thrombus (2 patients) and perioperative stroke (1 patient). After 6 months, 30 (86%) patients were arrhythmia-free, whereas 80% were also off antiarrhythmics. After 1 year, 28 (82%) patients were arrhythmia-free, 79% were off antiarrhythmics and 47% were off anticoagulation treatment. Four (10.5%) serious postoperative complications occurred, including 1 stroke, 1 right phrenic nerve palsy and 2 pneumothoraxes with a need for drainage. Significant improvements were observed in echocardiographic, functional and serological parameters.CONCLUSIONS: Hybrid ablation is an effective treatment strategy for patients with persistent or long-standing persistent AF. Over 80% of patients were arrhythmia-free 1 year after the procedure. Sinus rhythm restoration was accompanied by improvements in functional, echocardiographic and serological markers.