胸腔镜辅助微创与导管射频消融治疗持续性心房颤动的对比研究  

Efficacy comparison between video-assisted minimally invasive radiofrequency ablation and catheter ablation in the treatment of persistent atrial fibrillation

作　　者：王坚刚[1] 孟旭[1] 李岩[1] 韩杰[1] 许春雷[1] 崔永强[1] 董建增[2] 马长生[2] 

机构地区：[1]首都医科大学附属北京安贞医院心外科9病房,100029 [2]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2011年第5期429-433,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金，北京市科技新星计划

摘　　要：目的 回顾性研究胸腔镜辅助微创与导管射频消融治疗持续性心房颤动（房颤）的临床疗效.方法 对北京安贞医院172例持续性房颤患者进行射频消融,83例行胸腔镜辅助微创射频消融（微创组）,另89例行环同侧肺静脉左心房线性消融（导管组）.其中男116例,女56例;年龄32～80（56±12）岁.房颤病史平均（72 ±68）个月.随访1.0～3.6（2.2±0.8）年.结果 全组无手术死亡.随访期间死亡3例：微创组1例猝死;导管组1例死于脑出血,1例猝死.全组术后窦性心律67例（39.0%）,起搏心律4例（2.3%）,心房扑动（房扑）、房性心动过速样心律29例（16.9%）,房颤心律72例（41.9%）.出院时窦性心律在微创组和导管组分别为53例（63.9%）和78例（87.6%）;房颤心律在微创组和导管组分别为24例（28.9%）和4例（4.5%）,P〈0.01.末次随访为窦性心律在微创组和导管组分别为65例（79.3%）和54例（62.1%）,）房颤/房扑心律微创组和导管组分别为14例（17.1%）和24例（27.6%）,P=0.028.对两组随访资料的房颤/房扑心律复发和抗心律失常药物进行Kaplan-Meier分析,微创组均优于导管组,两组之间比较差异有统计学意义.结论 胸腔镜辅助微创射频消融治疗持续性房颤安全可行,疗效满意.进行与导管消融之间的随机对照研究势在必行.Objective To compare the efficacy of the video-assisted minimally invasive radiofrequencv ablation in comparison with catheter ablation fbr the treatment of persistent atrial fibrillation （AF）.Methods A total of 172 patients[116 male,mean age（56 ±12）years]with persistent AF underwent ablation procedures during the last 4 years in our institute（83 patients underwent video-assisted minimally invasive radiofrequeney ablation,group MIA and 89 patients underwent circumferential pulmonary vein linear ablation,group CA）. Mean duration of preoperative AF was（72 ±68）months.Patients were follow-uped for a period of 1 to 3.6 years[mean（2.2±0.8）years].Results There was no procedure related death.During follow-up,one patient died of encephalorrhagia in CA group,one patient died of sudden death in each group. At the end of the procedure,there were 67 sinus rhythm（39.0%）,4 pacing rhythm（2.3%）,29 atrial flutter or atrial tachycardia（16.9%）and 72 AF（41.9%）.Before discharge,sinus rhythm was recofded in 53 patients（63.9%）of MIA group and in 78 patients（87.6%）of CA group;AF recorded in 24 patients（28.9%）of MIA group and in 4 patients（4.5%）of CA group（P〈0.01）.At the latest follow-up,sinus rhythm was recorded in 65 patients（79.3%）of MIA group and in 54patients（62.1%）of CA group;AF or atrial flutter was recorded in 14 patients（17.1%）of MIA group and in 24 patients（27.6%）of CA group（P=0.028）.The Kaplan-Meier survival analysis showed that the long-term efficacv of MIA is superior to CA in terms of incidence of free of AF, AF recurrence and antiarrhythmic drugs（P=0.03,P=0.028,P=0.017,respectively）.Conclusions The video-assisted minimally invasive ablation was safe and effective,and had an optimistic long-term success rate for patients with long-lasting persistent AF.Thus,a randomized study comparing the long-term efficacy between the two procedures for patients with long-lasting persistent AF is warranted.

关 键 词：心房颤动 导管消融术 胸腔镜 

分 类 号：R541.75[医药卫生—心血管疾病]