胸腔镜辅助下心房颤动射频消融同期或单独行左心耳夹闭的近期效果分析

Thoracoscopy-assisted radiofrequency ablation and/or left atrial appendage exclusion for atrial fibrillation

目的探讨胸腔镜辅助下心房颤动(atrial fibrillation,房颤)射频消融同期或单独行左心耳夹闭手术效果的有效性与安全性。方法回顾性分析2018年11月—2020年8月北京天坛医院收治的12例孤立性房颤患者的临床资料,其中男7例、女5例,平均年龄(65.2±5.3)岁。阵发性房颤2例,持续性房颤1例,永久性房颤9例。结果围手术期无死亡,5例行房颤射频消融+左心耳夹闭,6例行单独左心耳夹闭,1例行左心耳部分缝扎。射频消融+左心耳夹闭平均手术时间(293±70)min,术后即刻转窦性心律2例(2/5),2例(2/5)电复律后转窦性心律,1例(1/5)未转窦性心律。单独左心耳夹闭手术时间(71±14)min,左心耳夹(11例,100.0%)位置良好未见移位。术后无脑卒中发生。术后1例出现胸腔积液,1例出现皮下气肿,未见伤口愈合不良。结论胸腔镜辅助下房颤射频消融同时或单独行左心耳夹闭,简化了手术方法,减低了手术风险,但是需要大样本研究证实其远期效果。

Objective To investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation(AF) and/or left atrial appendage exclusion(LAAE). Methods The clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF. Results No patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed. Conclusion Thoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AFassociated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.