外科和介入复合治疗难治性心房颤动初步经验

Preliminary Experience of Hybrid Thoracoscopic Surgery and Catheter Ablation in Treating the Patients of Refractory Atrial Fibrillation

目的:评估胸腔镜外科射频消融联合介入导管消融治疗长程持续性心房颤动(房颤)的安全性、可行性,总结初步的治疗经验。方法:2014-04至2016-03,连续在我院接受胸腔镜外科射频消融联合介入导管消融治疗长程持续性房颤患者15例,男性13例,平均房颤持续时间(4.0±3.9)年。所有患者先在胸腔镜下应用双极射频消融钳行肺静脉隔离、左心房后壁隔离、Waterston’s沟神经节消融、左心耳切除和Marshall韧带离断;然后左心房三维建模,结合左心房电压标测,应用导管消融对胸腔镜外科消融线进行强化或修饰消融,确保双向阻滞,同时消融左心房嵴部、二尖瓣峡部,部分患者消融左心房前壁和三尖瓣峡部。术后3个月、6个月、12个月进行定期随访。结果:13例患者术毕即转复为窦性心律,无手术并发症。15例患者平均随访(12.1±11.5)个月。2例转复窦性心律患者在术后3个月因心房扑动再次介入导管消融恢复窦性心律。总体治疗成功率86.7%(13/15),均未再服用抗心律失常药物。结论:胸腔镜外科射频消融联合介入导管消融治疗长程持续性房颤是一种创伤小、安全而有效的方法。

Objective： To evaluate the safety and feasibility of hybrid thoracoscopic surgery and catheter ablation in treating the patients of long-standing persistent atrial fibrillation （AF） with preliminary experience. Methods： A total of 15 consecutive relevant patients treated in our hospital by hybrid thoracoscopic surgery and catheter ablation from 2014-04 to 2016-03 were studied. The average AF time was （4.0±3.9） years including 13 male. All patients received thoracoscopic surgical ablation including pulmonary vein isolation, left atrial （LA） posterior wall isolation, Waterston＇s groove Ganglionated plexi ablation by bipolar radiofrequency ablation clamp and LA appendage removal, Marshall ligament dividing. Then establishing LA 3D-modeling, based on LA 3D voltage mapping, catheter ablation was conducted to reinforce surgical ablation or modification in order to confirm bidirectional blocking. Meanwhile, LA ridge and mitral isthmus ablation was performed, some patients received LA anterior wall and tricuspid isthmus ablation. The patients were followed-up at 3, 6 and 12 months after the procedure. Results： 13 patients were restored to sinus rhythm after the procedure and no operative complications occurred. The average follow-up time was （12.1±11.5） months. 2 patients with recovered sinus rhythm had re-catheter ablation since atrial flutter at 3 months post-procedure and sinus rhythm was restored. The overall success rate was 86.7% （13/15）, no patient had anti-arrhgthmia medication. Conclusion： Hybrid thoracoscopic ablation and catheter ablation have been a minimally invasive, safe and effective method in treating the patients of long-standing persistent AF.