内外科杂交消融治疗心房颤动患者的长期随访结果

Long-term follow-up results of one-stage hybrid ablation for refractory atrial fibrillation

目的探索经内外科一站式杂交消融手术(胸腔镜下心外膜射频消融联合心内膜射频导管消融)治疗的难治性心房颤动(房颤)的长期有效性与不良事件发生率。方法本研究为回顾性横断面研究。选择2015年8月至2018年1月在上海市第六人民医院接受内外科一站式杂交手术的房颤患者,收集患者临床资料并完成5年随访,评估内外科一站式杂交手术的治疗成功率及患者预后。结果21例房颤患者接受内外科一站式杂交手术,其间部分复发患者经再次抗心律失常治疗后部分恢复窦性心律。随访至5年,共有3例死亡,1例失访,11例维持窦性心律,总治疗有效率为64.7%(11/17)。随访过程中,有1例患者发生脑卒中,4例患者心力衰竭再入院治疗。死亡、脑卒中均发生在术后2年内,术后3~5年新增2例心力衰竭加重患者。结论内外科一站式杂交术治疗房颤,长期复发率低且并发症发生率较低,此术式应用于房颤治疗的前景良好。

Objective To explore the long-term efficacy and incidence of adverse events in patients with refractory atrial fibrillation treated by one-stop hybrid ablation(thoracoscopic surgical radiofrequency ablation and catheter radiofrequency ablation).Methods Patients were enrolled in trial who assigned to hybrid ablation from August 2015 to January 2018 in Shanghai Sixth People′s Hospital.The clinical data of the patients were collected and followed up for 5 years.Treatment effect was evaluated by the recurrence of atrial fibrillation and complication.Results Of 21 patients underwent hybrid ablation,patients who had a recurrence of atrial fibrillation were partially restored to sinus rhythm after antiarrhythmic treatment.During the 5-year follow-up,the total maintenance rates of sinus rhythm was 64.7%(11/17),which 11 patients maintained sinus rhythm,3 patients died and 1 lost to follow-up.One patient suffered a stroke,and 4 patients were readmitted to hospital for heart failure over the whole period.The complications mentioned before mainly occurred within 2 years after the operation but heart failure occurred in 2 patients after that.Conclusion The long-term recurrence rate and complication rate of hybrid surgery are low for the treatment of atrial fibrillation.Therefore,this operation has a good prospect in clinical practice.