胸腔镜下外科消融和复合技术治疗持续性心房颤动的病例对照研究

Hybrid surgical and interventional ablation versus video-assisted thoracoscopic surgical ablation for persistent atrial fibrillation: A case control study

目的分析外科和介入复合技术(hybrid surgical and interventional ablation,HA)治疗持续性心房颤动(房颤)疗效是否优于单纯胸腔镜下外科射频消融(video-assisted thoracoscopic surgical radiofrequency ablation,VATS-RA)。方法 2010年9月至2017年12月,连续79例持续性房颤患者在阜外医院接受VATS-RA或HA治疗,其中,VATS-RA治疗60例,为单纯外科组,男48例、女12例,平均年龄(56.0±7.6)岁;HA治疗19例,为复合组,男14例,女5例,平均年龄(58.0±7.3)岁。术后3个月、6个月、1年和每年进行定期随访。术后恢复窦性心律定义为,随访期间24 h或7 d动态心电图提示窦性心律并未出现持续时间≥30 s的快速性房性心律失常(房颤、心房扑动或房性心动过速)。结果 78例(98.7%)持续性房颤患者完成随访。尽管复合组术前左房前后径[(49.1±5.3)mm]明显大于单纯外科组[(41.7±6.2)mm,P<0.001],但复合组总体窦性心律维持率(94.7%)优于单纯外科组(64.4%,P=0.011),复合组免除抗心律失常药物(AADs)治疗和导管消融窦性心律维持率(84.2%)也优于单纯外科组(50.8%,P=0.010)。结论 HA治疗持续性房颤疗效优于单纯VATS-RA,但需要更大样本量的前瞻性研究进一步验证。

Objective To verify whether hybrid surgical and interventional ablation（HA） for the treatment of persistent atrial fibrillation （AF） is superior to video-assisted thoracoscopic surgical radiofrequency ablation （VATS-RA）. Methods From September 2010 to December 2017, 79 consecutive patients with persistent AF underwent VATS-RA or HA in Fuwai Hospital. VATS-RA was performed in sixty patients （a stand-alone surgical group, 48 males and 12 females, at average age of 56.0±7.6 years, and HA was performed in nineteen patients （a hybrid group, 14 males and 5 females, at average age of 58.0±7.3 years）. Follow-up was completed at 3 months, 6 months, 1 year and annually thereafter, Postoperative sinus rhythm was defined as sinus rhythm recorded in 24-hour or 7-day Holter during follow-up, without exhibited rapid atrial tachyarrhythmia ≥30 s including AF, atrial flutter, or atrial tachycardia. Results Seventy-eight patients （98.7%） completed the follow-up. Although the preoperative left atrial diameter （49.1±5.3 mm） in the hybrid group was significantly greater than that in the stand-alone surgical group （41.7±6.2 mm, P〈0.001）. Overall sinus rhythm maintenance rate in the hybrid group was significantly greater than that in the stand-alone surgical group （94.7% versus 64.4%, P-0.011）. And sinus rhythm maintenance rate free from anti-arrhythmic drugs （AADs） and catheter ablation in the hybrid group was significantly greater than that in the stand-alone surgical group （84.2% versus 50.8%, P=0.010）. Conclusion HA is superior to VATS-RA in the treatment of persistent AF, but a larger sample size is needed for further validation in prospective randomized studies.