小切口直视下肺静脉隔离术治疗孤立性心房颤动的近中期疗效观察

Mid-term results of epicardial pulmonary vein isolation for treatment of lone atrial fibrillation via bilateral subaxillay minithoracotomy

目的:总结小切口直视下肺静脉隔离,及左心耳切除治疗孤立性心房颤动的临床经验及近中期疗效。方法:2005年9月至2013年8月,31例孤立性心房颤动患者通过腋下小切口径路,直视下用Atricure双极射频消融系统,行双侧肺静脉隔离及左心耳切除、Marshall韧带切断。结果:无围术期死亡、Ⅲ°房室传导阻滞、脑卒中及大出血等严重并发症,气管插管时间(4.3±2.4)h,平均住院天数(5.9±2.8)d。26例患者术毕转复窦性心律,2例电复律后转复,3例5d内转复。平均随访19.4个月,2例心房颤动复发,3例出现阵发性房性期前收缩。结论:小切口直视下射频消融治疗孤立性心房颤动,无需特殊器械辅助,易于推广,近中期效果良好。

Objective：To summarize clinical experience of pulmonary vein isolation for surgical treatment of lone atrial fibrillation through subaxillay minithoracotomy.Methods：Between September 2005 and Aug 2013,31 drug-resistant and symptomatic consecutiye lone atrial fibrillation patients were enrolled this retrospective study.Of these patients,22 were men and 9 were women,with a mean age of（57 ± 7.2） years.Mean duration of atrial fibrillation was（35 ± 15.2）months.4 patients were permanent atrial fibrillation and 27 patients were paroxysmal atrial fibrillation.All the patients underwent pulmonary vein isolation procedure with bipolar Atricute ablation systems on beating heart via bilateral subaxillary no video-assisted minithoracotomy access.The procedure includes bilateral pulmonary vein isolation,taking down of the ligament of Marshall and resection of left atrial appendage by the mean of direct vision.Preoperative,perioperative,and post operative data were collected retrospectively.Follow-up was conducted by out-patient visits at 3,6,and 12 months,and annually thereafter.At each visit,symptomatic history,physical examination,electrocardiogram and twenty-four-hour Holter monitoring were obtained.Results：All the patients survived the operation.All procedures were completed as planned without any conversions to sternotomy.There were no major complications,such as Ⅲ° atrial ventricular block,stroke,hemorrhage and so on.Average duration of intubation was（4.3 ± 2.4） hours and average hospital stay was（5.9 ± 2.8）days.26 patients recovered to sinus rhythm immediately intra-operation and one was electrical converted to sinus rhythm.Three patients converted to sinus rhythm within five days.At a mean follow-up period of 19.4 months,there was no late mortality or late stroke.Freedom from recurrence of atrial fibrillation was 87％,93％,94％ and 91％ at 3,6,12,and 24 months,respectively.Freedom from both atrial fibrillation and the need for class Ⅰ or class Ⅲ antiarrhythmic medication was 75％,90％,91％ and 90％ at 3,6,12,and 24 months,respectively.Freedom from symptoms was 86％,91％,93％ and 97％ at 3,6,12,and 24 months,respectively.Recurrence of atrial fibrillation was detected in one patient and two patients showed paroxysmal atrial flutter.All of them were controlled with antiarrhythmic medications.Conclusion：Epicardial pulmonary vein isolation through subaxillay minithoracotomy without video-assisted using bipolar radiofrequency energy is effective treatment for lone atrial fibrillation,which can be a valuable supplementary option of endoscopic procedure in china.