内窥镜下心外膜微波消融治疗心房颤动的早期结果

Clinical efficacy of endoscopic epicardial microwave ablation for isolated atrial fibrillation

目的探索内窥镜下心外膜微波消融术治疗心房颤动的应用和初步临床效果。方法从2004年7月至10月共对5例持续性心房颤动患者采用胸部小切口、在VASOVIEW5内窥镜下进行心外膜微波消融。使用FLEX10微波探头将左、右肺静脉周围包绕,65W、90S连续消融,在肺静脉周围造成环形消融线。所有病例均于手术前后行超声心动图及24H动态心电图检查,并进行随访。结果消融并予体表电复律后均恢复窦性节律,平均手术时间2·5H,平均消融时间35·0MIN,无手术相关并发症;术后3、6、12个月的随访中,有4例(80%)保持窦性心律,左心房直径缩小,功能恢复。结论通过内窥镜行心外膜微波消融术治疗心房颤动是安全有效的方法。

Objective To assess the efficacy of endoscopic epicardial microwave ablation, a new completely endoscopic technique, for isolated atrial fibrillation （AF）. Methods From July to October of 2004, 5 patients with isolated permanent AF underwent this procedure. We performed epicardial microwave ablation using FLEX10 probe under the guide of VasoView 5 endoscope. The probe was placed around left and right pulmonary vein orifices, the microwave application was set 65 W/90 s, and a continuous ablation line was obtained encircling the pulmonary veins. Echocardiography and electrocardiography were carried out in all patients before and after operation. Results Five patients received electrical conversion after ablation. Average ablation time was 35.0 min and average procedure time was 2. 5 h without any procedurerelated complications. At the 3-month, 6-month and 12-month follow-up, 4 patients （80%） were in sinus rhythm, associated with a reduced left atrial diameter and an improved cardiac function. Conclusion Endoscopic epicardial microwave ablation for isolated atrial fibrillation appears to be safe and effective.