胸腔镜辅助下心外膜射频消融治疗持续性房颤的远期结果

Long-term Results of Video-assisted Thoracoscopic Epicardial Radiofrequency Ablation for Persistent Atrial Fibrillation

目的评估胸腔镜辅助下心外膜射频消融治疗持续性房颤的远期结果。方法 2010年9月至2016年12月,连续32例持续性房颤患者在阜外医院接受胸腔镜辅助下射频消融治疗。术后3、6、12个月和随后每年进行定期随访,随访时完成动态心电图检查和问卷调查,分析随访结果。结果全组患者男性24例,女性8例,平均年龄56.6±7.6岁,房颤病史时间7.9±7.2年,16例患者有介入导管消融史。全组无死亡,均顺利出院。31例(96.9%)患者完成随访,平均随访39±18个月。无患者出现心力衰竭、栓塞或出血并发症。3例(9.7%)患者因房颤复发再次行导管射频消融。总体窦性心律维持率为77.4%,免除抗心律失常药物治疗和再次消融窦性心律维持率为64.5%。结论胸腔镜辅助下心外膜射频消融技术治疗持续性房颤远期疗效确切,可让大部分患者恢复窦性心律,无心血管不良事件。

Objective To assess the long-term outcome of thoracoscopic epicardial radiofrequency ablation for persistent atrial fibrillation.Methods From September 2010 to December 2016, 32 consecutive patients with persistent atrial fibrillation were treated with video-assisted thoracoscopic radiofrequency ablation at Fuwai Hospital. Follow-ups were performed at 3 months, 6 months, 1 year, and annually thereafter. During follow-up, Holter electrograms and questionnaires were completed. Results There were 24 males and 8 females in the whole group, with an average age of 56.6±7.6 years. The duration of atrial fibrillation was 7.9±7.2 years. Sixteen patients had a previous catheter ablation. No deaths occurred in the whole group and they were all discharged. Thirty-one patients（96.9%） completed the follow-up with an average of 39±18 months. No patient developed heart failure, embolism or bleeding complications. Radiofrequency catheter ablation was performed in 3 patients（9.7%） due to atrial fibrillation recurrence. The overall sinus rhythm maintenance rate was 77.4%, and free from anti-arrhythmic drug therapy and re-ablation sinus rhythm maintenance were 64.5%. Conclusions Most patients with persistent atrial fibrillation can restore sinus rhythm with no cardiovascular adverse events when treated by video-assisted thoracoscopic epicardial radiofreguency ablation.