胸腔镜辅助下心外膜射频消融治疗阵发性心房颤动

Outcome of video-assisted thoracoscopic bipolar epicardial radiofrequency ablation for paroxysmal atrial fibrillation

目的回顾性分析并评估单中心胸腔镜辅助下双极射频消融治疗阵发性心房颤动（房颤）的安全性和有效性。方法2010年9月至2016年12月，连续72例阵发性房颤患者在阜外医院接受胸腔镜辅助下心外膜双极射频消融治疗，其中男50例，女22例，年龄（56．5±10．5）岁。房颤病史（6．5±4．8）年，45例有介入导管消融史。术后3、6、12个月和以后每年定期随访患者窦性心律维持情况。单因素和多因素logistic回归模型分析术后房颤复发的危险因素。结果全组手术顺利，无围手术期死亡。1例术中出血转为正中开胸，全组均顺利出院。随访3～60个月，平均（28±18）个月，69例完成随访。全组窦性心律维持率73．9％，免于抗心律失常药物窦性心律维持率62．3％。亚组分析结果显示，左心房前后径≤40mm和〉40mm的患者窦性心律维持率分别为80．0％和57．9％（P=0．035）。多因素logistic回归模型分析显示左心房前后径〉40mm是术后房颤复发的独立危险因素。结论胸腔镜辅助下心外膜射频消融是一种治疗阵发性房颤安全有效的方法，左心房前后径≤40mm患者疗效更优。

Objective This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic bipolar radio- frequency ablation in the treatment of isolated paroxysmal atrial fibrillation. Methods From September 2010 to December 2016, Seventy-two consecutive patients with paroxysmal atrial fibrillation underwent video-assisted thoracoscopic bipolar radio-frequency ablation at Fuwai Hospital. There were 50 males and 22 females with an average age of（ 56.5±10.5 ） years and du- ration of atrial fibrillation with（6.5±4.8） years. 45 patients had previous catheter ablation. The patients were followed up at postoperative 3 months, 6 months, 1 year and annually. Success of ablation was defined as sinus rhythm and no duration of ≥ 30 s for rapid atria/arrhythmias, including atrial fibrillation, atrial flutter or atria/tachyeardia in 24 h Holter examination. Univariate and muhivariate logistk＂ regression models were used to analyze the risk factors for atrial fibrillation recurrence. Results One patient converted to sternotomy due to bleeding on operation. All patients were successfully discharged. 69 patients completed follow-up, with an average follow-up of（28≥18）months（3 -60 months）. The overall success rate was 73.9% , and the success rate without antiarrhythmie drug was 62.3%. Subgroup analysis showed that the success rate was 80% when left at-rial anterior mad posterior diameter（LAD）≤40mm, and 57.9% when LAD 〉 40 mm （ P =0. 035 ）. Multivariate logistic regression analysis showed that LAD 〉40mm was an independent risk factor for postoperative recrrence of atrial fibrillation. Conclusion Video-assisted thoraeoseopic bipolar radiofrequency ablation is a safe and effective method for the treatment of parox-ysmal atrial fibrillation, especially in patients with LAD ≤40mm.