Thoracoscopic treatment of atrial fibrillation on the beating heart

近年来，心律失常的外科治疗得到了广泛的应用。尤其是房颤的外科治疗：迷宫术已经引起了人们的注意，并被许多心脏外科医生所采用。本手术通过切开缝合双侧心房，恢复窦房传导，可治愈心房颤动。但也有一些缺点，如切线复杂、主动脉阻断时间延长、出血等。为了解决这些问题，人们开发了其他烧蚀设备来代替切割缝合技术，但目前还没有解决所有这些问题的设备。我们的重点是冷冻消融和红外线凝固系统。7例患者应用了心外膜冷冻消融技术(LAVIE)。除1例患者外，其余患者均在术后数周内自行恢复窦性心律。这些病例是世界上第一例，并于2004年发表在《胸外科年鉴》上。红外凝固器的疗效也在犬的动物实验中得到了证实，研究结果将发表在今年的《胸外科年鉴》上。红外凝固器的首次临床应用于2005年，但由于心房组织的碳化而失败。我们注意到不仅消融时间和能量输出对电凝深度的控制都是重要的，并将电凝器改进为能量输出可控的电凝器。这一结果在2005年5月日本起搏和电生理学会第20次会议上公布。最新型号的红外电凝器已准备好临床使用。

Recently, surgical treatment of arrhythmia has been widespread. Especially, the surgical treatment of the atrial fibrillation : MAZE procedure has been noticed and has been done by many cardiac surgeon. This procedure can cure the atrial fibrillation by means of cutting and sewing both atrium to recover sinoatrial conduction. However, there are several drawbacks e.g. complicated cutting line, prolongation of the aortic crosclamp time, bleeding. Instead of cut and sew technique, other ablation devices have been developed to solve these problems, there is no device which solve all of these problems. We focused on cryoablation and infrared coagulation systems.Epicardial cryoablation technique (LAVIE) was applied to seven patients. All patient except one has recovered sinus rhythm several weeks after the procedure spontaneously. These are the first cases in the world and presented in The Annals of Thoracic Surgery in 2004. The efficacy of the infrared coagulator also demonstrated in the animal experience using canine and the results will be published in The Annals of Thoracic Surgery this year.The first clinical application of infrared coagulator has been done in 2005, however it failed because of the carbonization of the atrial tissue. We noticed that not only the ablation duration but also energy output is important to control the depth of coagulation, and modified the coagulator to be an energy output controllable one.These results were presented at the 20^<th> Meeting of Japanese pacing and electrophysiological Society in May 2005.The latest model of infrared coagulator is ready to use clinically.