Minimally invasive surgical pulmonary vein isolation alone for persistent atrial fibrillation: Preliminary results of epicardial atrial electrogram analysis
Minimally invasive surgical pulmonary vein isolation alone for persistent atrial fibrillation: Preliminary results of epicardial atrial electrogram analysis
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DOI：
10.1016/j.athoracsur.2008.04.081
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发表时间：
2008-10-01
影响因子：
4.6
通讯作者：
Meng, Xu
中科院分区：
文献类型：
--
作者：
Li, Hui;Li, Yan;Meng, Xu
背景。微创手术肺静脉隔离已成为孤立性心房颤动的替代疗法。本研究通过心外膜心房电图评估了该手术对持续性心房颤动的效果。方法。连续招募了五名患有孤立性持续性心房颤动的患者。在微创手术肺静脉隔离之前和之后进行术中电生理学测试。分析了记录的形态和心房颤动周期长度。结果。 5 名患者记录了 60 个部位。在这些部位记录了三种类型的双极电图。消融后，肺静脉和近心窦电图全部变为I型，所有近端左心房电图保持不变。左心房近端的房颤周期长度短于肺静脉的房颤周期长度。在左心房近端部位记录的心房颤动周期长度与心房直径相关。肺静脉隔离后，左心房的房颤周期长度从 143 +/- 11 毫秒增加到 170 +/- 12 毫秒。 5例患者术后均出现房颤，均接受直流电复律，术后给予胺碘酮治疗。出院时房颤的消除率为 100%，随访 6 个月时为 60%。结论。肺静脉外的异位病灶在持续性心房颤动中起重要作用。微创手术肺静脉隔离可能不足以终止持续性房颤。然而，肺静脉隔离手术可以减缓心房颤动并使补充药物复律有效。
Background. Minimally invasive surgical pulmonary vein isolation has become an alterative therapy for lone atrial fibrillation. This study evaluated the effect of the procedure on persistent atrial fibrillation by epicardial atrial electrography.Methods. Five consecutive patients with lone persistent atrial fibrillation were enrolled. Intraoperative electrophysiology tests were performed before and after minimally invasive surgical pulmonary vein isolation. Morphology of the recordings and atrial fibrillation cycle length were analyzed.Results. Sixty sites were recorded in 5 patients. Three types of bipolar electrogram were recorded at these sites. After ablation, all electrograms changed into type I in pulmonary veins and proximal antra, and remained unchanged in all proximal left atria. Atrial fibrillation cycle length at the proximal left atrium was shorter than that at the pulmonary veins. Atrial fibrillation cycle length recorded at proximal left atrium sites correlated with atrial diameter. The atrial fibrillation cycle length of the left atrium increased from 143 +/- 11 to 170 +/- 12 ms after pulmonary vein isolation. All 5 patients had atrial fibrillation immediately after the procedure and were treated with direct-current cardioversion and received amiodarone postoperatively. Freedom from atrial fibrillation was 100% at discharge and 60% at 6 months' follow-up.Conclusions. Ectopic foci outside the pulmonary veins play an important role in persistent atrial fibrillation. Minimally invasive surgical pulmonary vein isolation might not be sufficient for persistent atrial fibrillation termination. The pulmonary vein isolation procedure, however, slows atrial fibrillation and makes supplemental pharmacologic cardioversion effective.