Catheter ablation for atrial fibrillation after an unsuccessful surgical ablation and biological prosthetic mitral valve replacement: A pilot study
Catheter ablation for atrial fibrillation after an unsuccessful surgical ablation and biological prosthetic mitral valve replacement: A pilot study
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手术消融和生物二尖瓣置换术失败后的心房颤动导管消融：一项试点研究
DOI：
10.1016/j.jcma.2014.01.012
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发表时间：
2014
影响因子：
3
通讯作者：
Y. Odarenko
中科院分区：
文献类型：
--
作者：
S. Mamchur;I. Mamchur;E. Khomenko;E. Gorbunova;I. Sizova;Y. Odarenko
背景二尖瓣（MV）疾病和心房颤动（AF）患者同时接受人工瓣膜置换术和射频（RF）消融术;然而，这种联合手术仅在68-82%的病例中恢复窦性心律（SR）。在手术消融无效的患者中，使用生物人工瓣膜不仅是在左心房（LA）进行安全导管消融术的良好选择，而且还提供了一种停止口服抗凝剂的方法。本研究的目的是评估导管消融术治疗二尖瓣置换术后房颤的生物假体和无效的外科消融procedure.Methods10例年龄为48 ± 7岁的连续患者参加了这项研究。所有患者均患有与风湿性瓣膜疾病相关的长期持续性AF，通过生物瓣膜置换二尖瓣和外科射频消融术进行治疗。在术后后期，所有患者都有复发的血流动力学显著的AF，需要反复复律。术后1年至3年，进行导管消融术，包括肺静脉（PV）再隔离以及LA顶部和二尖瓣峡部的神经节丛或线性病变消融。术后3个月、6个月、12个月进行疗效评估。术后6-9个月无心律失常发生。在9例SR患者中观察到LA顿抑，表现为二尖瓣血流中的“A”波和PV血流中的逆行波的缺失或减少。其中5例患者的LA收缩功能在1-6个月内恢复。人工瓣膜功能障碍没有检测到任何patients.ConclusionCatheter消融是一种有效的方法，AF治疗无效的外科射频消融术和生物假体二尖瓣置换术。生物瓣膜MV的使用允许进行安全的导管消融，而不会导致后续的假体功能障碍。
BackgroundPatients with mitral valve (MV) disease and atrial fibrillation (AF) undergo simultaneous prosthetic valve replacement and radiofrequency (RF) ablation procedure; however, this combinational procedure restores sinus rhythm (SR) in only 68–82% of the cases. In patients with ineffective surgical ablation, the use of a biological prosthetic valve might not only be a good choice to perform safe catheter ablation procedure in the left atrium (LA), but also provide a way to discontinue administration of oral anticoagulants. The objective of this study was to assess the efficacy of catheter ablation for AF after MV replacement with a biological prosthesis and an ineffective surgical ablation procedure.MethodsTen consecutive patients aged 48 ± 7 years were enrolled in this study. All patients had long-persistent AF associated with a rheumatic valve disease, which was treated by MV replacement with a biological prosthesis and a surgical RF ablation procedure. In the late postoperative period, all the patients had recurrent hemodynamically significant AF, which required repeated cardioversions. From 1 year to 3 years after the surgery, catheter ablation was performed, including reisolation of pulmonary veins (PVs) with the ablation of ganglionic plexi or linear lesions on the roof of the LA and mitral isthmus. The efficacy was assessed at 3 months, 6 months, and 12 months after the procedure.ResultsRestoration of SR during ablation was achieved in all of the cases. In 6–9 months, all the patients were free of arrhythmia. LA stunning manifested by the absence or decrease of the “A” wave in the transmitral flow and the retrograde wave in the PV flow was observed in nine patients with SR. In five of the patients, LA contractile function was restored in 1–6 months. Prosthetic valve dysfunction was not detected in any of the patients.ConclusionCatheter ablation is an effective method for AF treatment following an ineffective surgical RF ablation procedure and biological prosthetic MV replacement. The use of bioprosthetic MVs allows for performing safe catheter ablation without subsequent prosthetic dysfunction.