胸腔镜辅助微创射频消融治疗持续性心房颤动

目的 回顾性研究胸腔镜辅助微创射频消融联合应用厄贝沙坦治疗持续性心房颤动的临床疗效.方法 对2006年1月至2009年12月收治的83例持续性心房颤动患者进行胸腔镜辅助微创射频消融治疗.其中男性58例,女性25例;年龄32～79岁,平均(57±11)岁.心房颤动病史平均(61±65)个月.随访1. 0～3.6年,平均(2.2±0.8)年.术后将患者随机分为厄贝沙坦组(n=42)与未用药组(n=41),比较两组心律转复情况.结果 全组无手术死亡,随访期间1例猝死.全组术后窦性心律38例(45.7%),起搏心律4例(4.9%),心房扑动、房性心动过速样心律5例(6.0%),心房颤动心律36例(43.4%).出院时窦性心律53例(63.9%),心房颤动心律24例(28.9%).末次随访窦性心律65例(80.2%),心房颤动/心房扑动心律14例(17.3%).厄贝沙坦组与未用药组的窦性心律和心房颤动/心房扑动心律分别为38例、3例和27例、11例,差异有统计学意义(P=0.017).Kaplan-Meier分析显示,厄贝沙坦组与未用药组随访中的非心房颤动/心房扑动心律差异有统计学意义(P=0.020).与未用药组相比,厄贝沙坦组心房颤动复发风险较低(RR=0.24,95%CI:0.087～0.637,P=0.004).结论 胸腔镜辅助微创射频消融治疗持续性心房颤动安全有效,术后联合应用厄贝沙坦可以有效降低心房颤动的复发.     

微创冷冻消融迷宫Ⅳ手术治疗二尖瓣病变合并心房颤动的近中期结果北大核心CSCD

目的分析胸腔镜辅助下微创切口二尖瓣手术同期行冷冻消融治疗心房颤动的近中期结果。方法回顾性分析中南大学湘雅二医院心血管外科2013年8月至2017年10月完成的68例胸腔镜辅助下右胸微创切口二尖瓣手术同期行冷冻消融治疗心房颤动患者的临床资料,其中男28例、女40例,平均年龄(38.7±9.3)岁。于术后定期复查24 h动态心电图观察心律情况。结果全组无手术死亡,1例再次开胸止血。出院时窦性心律转复率为95.8%。随访无死亡病例。术后第6个月、12个月、24个月、36个月的窦性心律转复率分别为93.5%、91.6%、90.3%、89.5%。结论胸腔镜辅助下微创切口二尖瓣手术合并心房颤动冷冻消融近中期结果安全可靠,心房颤动治疗效果确切。     

心脏直视手术中双极射频消融治疗心房颤动91例分析

目的 探讨心脏直视手术同期采用双极射频消融技术治疗心房颤动的方法和早、中期疗效.方法 2005年3月至2007年1月共91例心房颤动患者于心脏直视手术同期接受了双极射频消融手术治疗.阵发性心房颤动5例,持续性/永久性心房颤动86例.37例采用AtricureTM干式双极射频消融系统,54例采用CardioblateTM冲洗式双极射频消融系统.消融径线包括标准Cox-mazeⅢ手术、改良Cox Mini.maze手术和单纯左心房迷宫手术.结果 平均射频消融时间(14.1±6.7)min,未发生与消融有关的并发症.围手术期死亡3例.术后2例患者安装永久起搏器,1例患者发生脑卒中及下肢动脉栓塞.随访6～29个月,双极射频消融组在术后6、12及12个月以上的成功率均高于单极射频消融组.截至末次随访,阵发性心房颤动组的非心房颤动心律为100%,持续性/永久性心房颤动组为75.3%.AtricureTM组与CardioblateTM组间,以及3种射频消融路径组间的成功率无差异.结论 双极射频消融技术实施简便、安全,耗时短,疗效满意,是一种更为先进的手术方法.     

梅氏微创消融术治疗心房颤动207例

目的探索梅氏微创消融术治疗207例心房颤动(房颤)患者的有效性和安全性。方法分析我院2010年10月至2014年2月经梅氏微创消融术治疗房颤患者207例的临床资料,其中男111例、女96例,年龄(58.9±14.8)岁。阵发性房颤98例持续性房颤109例。手术通过左胸路径在全胸腔镜下施行房颤消融术式包括双极消融钳行双侧环肺静脉消融、连接两侧肺静脉的左心房顶部和左房后壁线性消融,心外膜自主神经节消融和左心耳切除等。结果平均手术时间为(112.4±32.5)min,无中转开胸。无起搏器置入等并发症和死亡。平均住院时间(7.2±3.1)d。术后平均随访(24.2±8.9)个月,187例(90.3%)患者维持窦性心律,20例患者术后不能维持窦性心律。术后复查无卒中、左心房血栓和肺静脉口狭窄。结论梅氏微创消融术治疗房颤是一种安全、有效的方法。     

全胸腔镜左心房后入路射频迷宫手术治疗32例孤立性心房纤颤

目的 探讨全胸腔镜下左心房后入路射频迷宫手术治疗孤立性心房纤颤的实用性及安全性.方法 2010年2月至201 1年11月,采用全胸腔镜下左心房后入路射频迷宫手术治疗孤立性心房纤颤(房颤)患者32例,其中阵发性21例,持续性11例.左后胸壁3个胸腔镜套管切口入胸,完全胸腔镜下视野,肺门后、食管前、左心房后切开心包,暴露左心房,行左心房迷宫射频消融、左心耳切除手术.结果 全组无手术死亡及严重手术并发症,1例因右肺上静脉出血中转开胸手术.手术时间87～238 min,术后住院期间10例出现阵发性房颤,出院时均为窦性心律.均出院,随访4～20个月,31例为窦性心律,1例持续性房颤患者出现阵发性房扑.结论 胸腔镜左心房后入路左心房暴露好,可行左心房射频消融、左心耳切除手术,效果好、创伤小.     

微创冷冻消融迷宫Ⅳ手术治疗二尖瓣病变合并心房颤动的近中期结果

目的 分析胸腔镜辅助下微创切口二尖瓣手术同期行冷冻消融治疗心房颤动的近中期结果.方法 回顾性分析中南大学湘雅二医院心血管外科2013年8月至2017年10月完成的68例胸腔镜辅助下右胸微创切口二尖瓣手术同期行冷冻消融治疗心房颤动患者的临床资料,其中男28例、女40例,平均年龄(38.7±9.3)岁.于术后定期复查24h...     

改良冲洗式双极射频消融手术治疗心房颤动

目的分析心瓣膜置换术中同期行改良冲洗式双极射频消融治疗心房颤动的临床效果。方法回顾性分析2009年4月至2011年6月安徽医科大学第二附属医院心瓣膜病合并心房颤动34例患者在体外循环下行心瓣膜置换术+改良冲洗式双极射频消融手术的临床资料,其中男21例,女13例;年龄41～76(50.5±11.3)岁。风湿性心脏瓣膜病31例,心瓣膜退行性病变3例;合并慢性持续性/永久性心房颤动27例,阵发性心房颤动7例。均采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融操作。消融手术包括双侧肺静脉的环形隔离、左心耳切除、左右心房消融(改良Cox-mazeⅢ手术路径)和Marshall韧带切除。术后常规予胺碘酮治疗。结果全组无死亡,除2例术后并发Ⅲ○房室传导阻滞、安装永久性心脏起搏器外,其余患者未发生与消融相关的并发症。术后31例转为非心房颤动心律(窦性心律25例,结性心律4例,起搏心律2例),3例维持心房颤动心律。随访3～20个月,29例维持窦性心律(85.3%),3例心房颤动心律,2例起搏心律。结论改良冲洗式双极射频消融治疗心房颤动安全、有效。     

微波消融治疗心房颤动在瓣膜手术中的应用

目的探索瓣膜手术同期微波消融治疗心房颤动的初步经验。方法对90例心脏瓣膜病合并持续性心房颤动患者,在瓣膜手术同期行心内膜微波消融。结果全组平均微波消融时间为(14.3±2.9)min。术后随访1~24个月,复发14例,治愈率84.4%,无消融相关并发症。结论瓣膜手术同期微波消融治疗心房颤动安全、有效。     

右胸小切口微创二尖瓣手术同期行心房颤动双心房射频消融术

目的总结右胸前外侧小切口微创二尖瓣手术同时行心房颤动(房颤)双心房射频消融术的临床经验。方法回顾性分析2012年1~10月中国医科大学附属第一医院二尖瓣病变合并持续性心房颤动11例患者的临床资料,其中男4例、女7例,年龄(54.5±6.5)岁。所有患者均经股动静脉内插管建立体外循环,经第3或第4肋间入胸,经房间沟切口行二尖瓣手术,以单极笔行肺静脉口射频消融,以双极笔经右心房切口行右心房及右侧肺静脉口射频消融,封闭左心耳。缝合左右心房切口。2例行二尖瓣成形术,其余9例行二尖瓣置换术。结果手术时间(282.9±67.8)min,体外循环时间(165.7±39.8)min,主动脉阻断时间(109.9±29.7)min,术后机械通气时间(7.4±3.2)h,住ICU时间(26.5±5.3)h,胸腔引流量(119.7±24.5)ml。随访时间(5.1±1.9)个月,术后3个月复查,窦性心律8例,阵发性心房颤动1例,持续性心房颤动2例。结论经右胸前外小切口行微创二尖瓣手术同期行心房射频消融术,术后恢复快,美容效果好,临床疗效满意。     

全胸腔镜下Box Lesion射频消融术治疗心房颤动近中期效果评估北大核心CSCD

目的评估全胸腔镜下Box Lesion射频消融术治疗心房颤动的近中期疗效。方法回顾性分析我院心脏外科2011年11月至2018年3月31例行全胸腔镜下Box Lesion射频消融术的心房颤动患者临床资料,其中男23例、女8例,平均年龄(66.17±8.32)岁。所有患者均不伴有需要手术处理的严重器质性心脏病。结果阵发性心房颤动20例,持续性心房颤动8例,长程持续性心房颤动3例。29例患者完成3年随访,2例患者于术后6个月失访。所有患者均成功完成手术,平均手术时间为(113.00±26.00)min,无围手术期死亡及相关并发症发生,全部患者术后立即转复为窦性心律。术后住院期间5例患者出现心房颤动,电复律后恢复为窦性心律。术后1、2和3年窦性心律维持率分别为62.9%、55.9%和52.4%,随访期间无患者死亡,未观察到手术相关并发症发生。结论全胸腔镜下Box Lesion射频消融术在保证手术效果的同时手术时间较短,手术创伤小,手术相关并发症少。     

外科射频消融术与经导管消融术治疗瓣膜病性房颤的疗效对比

目的 比较心内直视下射频迷宫术与介入导管消融术治疗合并心脏瓣膜病的心房颤动临床结果.方法 2004年1月到2006年3月因心脏瓣膜病合并心房颤动行瓣膜置换时加射频迷宫术60例,其中男34例,女26例;平均(57±11)岁.瓣膜置换术后在三维电解剖标测系统(CABTO)指导下进行经皮经导管环肺静脉消融治疗66例,其中男40例,女26例;平均(55±10)岁.结果 导管消融组随访(14±10)个月,窦性心律维持率64%.外科射频迷宫组随访(13±9)个月,窦性心律维持率75%,二者差异有统计学意义(P<0.05).对于病史小于1年、左房直径<50mm的阵发性房颤,导管消融组亦有较高的窦性心律维持率(分别为90%、82%).两组术后并发症无显著性差异.结论 射频迷宫术对瓣膜病合并心房颤动病人是简单、有效的治疗方法.若未行迷宫术,对于病史小于1年,左房直径小于50mm的阵发性心房颤动,瓣膜置换术后行经皮经导管消融术亦为一种有效的治疗方法.     

Biatrial radiofrequency ablation for atrial fibrillation: epicardial and endocardial surgical approach

Radiofrequency energy applied by means of surgical probes permits the ablation of atrial fibrillation (AF). This study presents our initial experience on 55 consecutive cardiac patients with permanent AF with radiofrequency ablation through biatrial epicardial and endocardial surgical approach. At discharge, 8.1% of the patients had persistent AF-atrial flutter. Hospital incidence of arrhythmias were, 9% of paroxysmal atrial fibrillation, 10.9% of atrial flutter, and 34.5% of persistent atrial fibrillation. After a mean follow-up of 7 months, 83.6% patients have recovered sinus rhythm, and echocardiographic biatrial contraction was re-established in 73%. Biatrial radiofrequency ablation applied from the endocardium and the epicardium has achieved satisfactory results, without increasing the surgical risk.     

Microwave surgical ablation for atrial fibrillation during off-pump coronary artery surgery using total arterial-Y-grafts: an early experience

This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF) ablation during off-pump arterial revascularisation using the left internal mammary to radial 'Y' graft (OPCABy) in patients with permanent and paroxysmal atrial fibrillation. From June 2004 to December 2005, sixteen consecutive patients were offered MWAF ablation and OPCABy. AF was permanent in 11 cases and paroxysmal in five. The MWAF ablation protocol exploited the use of either the Flex 4 or Flex 10 probe (Afx- Guidant, Santa Clara, CA). Spontaneous cardioversion was used to demonstrate conduction block. Data were collected prospectively. Patients were followed-up in outpatient clinic at 6 weeks, 3 months and 6 months after discharge. Sinus rhythm was seen in 75%, 67% and 71% of patients at conclusion of surgery, and 3 and 6 months postoperatively. Cardioversion to sinus rhythm was seen in 67% of patients with permanent AF and 80% of patients with paroxysmal AF. Spontaneous cardioversion at operation occurred in 12 patients, all of whom were in sinus rhythm at six months. The use of MWAF ablation during concomitant OPCABy surgery is an effective therapy in the short- to medium-term. Spontaneous return to sinus rhythm is a reliable intraoperative indicator of long-term success.     

Role of the Simultaneous Sequential Strategy for Failed Acute Sinus Restoration after Modified Left Maze Procedure for Persistent Atrial Fibrillation with Concomitant Mitral Surgery

Background We assessed whether the simultaneous sequential strategy could (1) achieve additional sinus restoration for those patients who were not in sinus rhythm while coming off bypass after modified left maze procedure and (2) attain the same long-term success rates as the bi-atrial maze procedure in patients with persistent atrial fibrillation (AF) and mitral valve disease. Materials and Methods Twenty-seven consecutive patients – ten men and 17 women with a mean age of 52 ± 13 years, all with persistent AF and mitral valve disease – underwent the modified maze procedure with the simultaneous sequential strategy. In the first phase, the modified left atrial maze operation was carried out with concomitant valvular surgery; the right side maze operation was subsequently carried out as a second phase of the sequential strategy only if AF re-appeared following the spontaneous restoration of heart beats during the operation. Results Twenty patients (74.1%) underwent the left atrial maze procedure only, and seven patients (25.9%) required the subsequent right atrial maze procedure as part of the sequential strategy. At a mean follow-up of 15.1 ± 7.7 months, six of the 27 patients (22.2%) who underwent additional right atrial maze procedure had restored sinus rhythm. At a mean follow-up of 17.8 ± 7.3 months, 24 of the 27 patients (88.9%) had restored sinus rhythm and 22 patients (81.5%) had restored bi-atrial transport function (right atrial filling fraction: 40.8 ± 11.7%; left atrial filling fraction: 22.9 ± 8.1%) after application of the sequential strategy. Conclusions Compared with modified left atrial maze procedure, the application of the simultaneous sequential strategy successfully restored sinus rhythm in an additional 22.2% of patients with persistent AF. The overall sinus conversion rate of 88.9% was comparable with that of the standard bi-atrial maze procedure.     

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

Purpose: Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients.Methods: A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months.Results: With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3–6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months (P = 0.350).Conclusions: There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.     

Surgical ablation of atrial fibrillation: the Columbia Presbyterian experience

BACKGROUND: The Maze III procedure is an effective surgical treatment for atrial fibrillation (AF). However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach. METHODS: This study involves patients undergoing surgical atrial fibrillation ablation (SAFA) at a single institution from 1999 to 2005. Type of concomitant procedures, preoperative clinical characteristics, and chronicity of AF were evaluated in overall patient population. Parameters including surgical approach, lesion pattern, and energy source used were collected intraoperatively. Clinical outcomes examined were postoperative rhythm success, stroke, early mortality, and long-term survival. RESULTS: Three hundred thirty-nine patients were identified. Three hundred twenty-eight (96.8%) patients had associated cardiac disease and underwent concomitant procedures; 75.8% of patients had persistent AF. Energy sources used were microwave (49.8%), radiofrequency (42.2%), and laser (8.0%). In 41.9% of cases a pulmonary vein encircling lesion was the only lesion created. Combination lesion sets were performed in the remaining cases. Rhythm success rates at 3, 6, 12, and 24 months were 74.1%, 68.2%, 74.5%, and 71.1%, respectively. Patients who underwent surgical removal of left atrial appendage by means of stapling or simple excision had no early postoperative stroke. Early mortality was 4.9%. Postoperative survival rates at 1, 3, and 5 years were 89.6%, 83.1%, and 78.0%. CONCLUSIONS: Surgical ablation of atrial fibrillation is a safe and effective procedure in restoring sinus rhythm with excellent postoperative survival rates. Further advancements in the field will eventually result in minimally invasive procedures with higher success rates.     

The biatrial cryo-maze procedure for treatment of atrial fibrillation: A single-center experience

Abstract

Objectives. The Cox-maze III procedure is the benchmark for atrial fibrillation (AF) surgery but has been replaced by surgical ablation. We evaluated our experience with biatrial cryoablation using the full Cox-maze III lesion pattern, and adhering follow-up to current guidelines. Design. Forty-three patients underwent the biatrial cryo-maze procedure as a concomitant (n = 37) or stand-alone procedure (n = 6). Mean age was 64.8 ± 9.5 years. Overall, AF was paroxysmal/persistent/permanent in 28/14/58%. Mean AF duration was 5.2 ± 6.5 years. Follow-up included prospective evaluation at 1, 3 and 12 months, long-term monitoring and transthoracic echocardiography. Results. No mortality and no complications related to the ablation procedure occurred. One patient suffered a stroke at 12 months. In the concomitant group, rhythm was sinus/pacing without AF/AF in 65/16/19% at three months, and 59/22/19% at 12 months. Five patients received new pacemakers (12%). In the stand-alone group, 5/6 (83%) patients had sinus rhythm with no AF at three and 12 months. Overall, 35/43 patients (81%) had sinus/paced rhythm at 12 months with no AF and no anti-arrhythmic drugs. Echocardiography showed satisfactory results in all patients. Conclusions. The biatrial cryo-maze procedure is safe and effective in surgical patients with concomitant AF, and could be considered for selected patients with lone AF.     

心内膜合并心外膜改良迷宫射频消融治疗心房纤颤

目的评价心内膜合并心外膜改良迷宫射频消融治疗心房纤颤的疗效。方法对295例房颤患者进行射频消融,185例进行心内膜加心外膜消融,另110例行心内膜消融。其中男124例,女171例;年龄19—77岁,平均（52±11）岁。90．8％（268／295）患者为风湿性病变。瓣膜手术289例,19例合并冠状动脉旁路移植术。结果手术死亡10例（3．4％）,其中4例死于低心排综合征,5例死于多器官功能衰竭,1例死于脑疝。随访3～47个月,平均（28±5）个月。随访每组各有1例死亡,均死于神经系统并发症。全组术后窦性心律占77．3％（228／295）,其中心内膜组70．9％（78／110）;心内膜加心外膜组81．1％（150／185）（P〈0．05）。最近随访的259例,窦性心律191例,占73．7％,其中心内膜组66．0％（64／97）,心内膜加心外膜组78．4％（127／162）（P〈0．05）。组织学可见心内膜组心肌细胞凝固性坏死灶集中在心内膜侧,近心外膜的坏死灶减少。而心内膜加心外膜组可见病灶分布组织全层,局部有炎症细胞浸润,心肌细胞网状结构破坏消失。结论心内膜合并心外膜射频消融是一种简易、安全、有效的治疗房颤的外科方法,而且效果优于心内膜消融。