微创双侧肺静脉消融治疗孤立性心房颤动15年随访  

Minimally invasive pulmonary vein ablation for isolated atrial fibrillation:15 years of follow-up experience

作　　者：胡秋明[1] 吴凯胜 郑帅[1] 张海波[1] 王盛宇[1] 王坚刚[1] HU Qiuming;WU kaisheng;ZHENG Shuai;ZHANG Haibo;WANG Shengyu;WANG Jiangang(Department of Vavular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所瓣膜外科中心,100029

出　　处：《心肺血管病杂志》2023年第10期1036-1041,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(82170311)。

摘　　要：目的:对2006年12月至2008年5月间接受外科胸腔镜辅助下双侧肺静脉隔离术孤立性心房颤动患者进行15年连续随访。评价这种微创外科射频消融手术治疗单纯性心房颤动的远期效果。方法:回顾性观察2006年12月至2008年5月,共109例接受外科胸腔镜辅助下双侧肺静脉隔离术及左心耳切除术的孤立性心房颤动患者。所有患者均为到药物治疗效果不理想或内科经导管射频消融失败的患者,其中包括阵发性心房颤动患者65例(59.6%)及非阵发性心房颤动患者44例(40.4%)。结果:平均随访时间为(140.7±55.5)个月。阵发性心房颤动及非阵发性心房颤动患者窦性心律转复率分别为35.4%和11.4%。总体术后脑血管事件发生率为5.5%。随访过程中死亡患者共27例(24.7%),均为非心源性死亡。结论:从远期效果来看,单纯行肺静脉消融治疗孤立性心房颤动是不理想,并且术后心房颤动复发率较高。但是长期随访中发现脑血管事件发生率仅为5.5%,初步证明左心耳切除在预防脑卒中的积极作用。Objective:This article describes the experience of up to 15 years of continuous followup of patients with isolated atrial fibrillation(AF)who underwent thoracoscopic-assisted bilateral pulmonary vein isolation between December 2006 and May 2008,in order to evaluate the long-term results of minimally invasive surgical radiofrequency ablation for isolated AF.Methods:From December 2006 to May 2008,a retrospective research was conducted on 109 patients with isolated AF who underwent surgical thoracoscopicassisted bilateral pulmonary vein isolation and left atrial appendage resection.All patients in this cohort were refractory to drug or transcatheter ablation,including 65(59.6%)with paroxysmal atrial fibrillation and 44(40.4%)with non-paroxysmal atrial fibrillation.Results:The mean follow-up time was(140.7±55.5)months.Sinus rhythm conversion rates were 35.4%and 11.4%in patients with paroxysmal AF and non-paroxysmal AF,respectively.The overall incidence of postoperative cerebrovascular was 5.5%.A total of 27(24.7%)patients died during follow-up,all of whom were noncardiac deaths.Conclusions:Pulmonary vein ablation for isolated AF is suboptimal in terms of long-term outcome and has a high recurrence rate of postoperative AF.However,the incidence of cerebrovascular events was 5.5%in long-term follow-up,which is preliminary evidence of the positive role of left atrial appendage resection in stroke prevention.

关 键 词：心房颤动 微创外科 随访 

分 类 号：R54[医药卫生—心血管疾病]