分站式杂交消融术与微创迷宫消融术治疗长程持续性心房颤动随机对照研究的中长期随访结果

目的评价并比较长程持续性心房颤动(房颤)患者接受分站式杂交消融术治疗的有效性是否优于单纯微创迷宫消融术。方法纳入广东省人民医院南海医院2017~2018年行微创迷宫消融术术后3个月维持窦性心律患者108例,其中男82例、女26例,年龄(56.5±9.4)岁。其中50例为杂交手术(HA)组,补充行导管射频消融术;另外58例为单纯外科(TEA)组。全组患者接受至少24个月的随访。结果总体随访时间为17.3~41.8(26.9±6.1)个月。HA组平均随访时间为8.2~40.6(27.5±5.7)个月,TEA组为17.3~41.8(26.4±6.7)个月,HA组和TEA组在术后6个月、12个月、24个月、36个月无抗心律失常药的窦性心律维持率分别为96.0%、90.0%、83.7%、83.7%和79.3%、75.9%、67.3%、63.1%(HR=0.415,95%CI 0.206~0.923)。结论分站式杂交消融术治疗长程持续性房颤的有效性优于单纯微创迷宫消融术,空白期过后补充行导管消融术,与未行导管消融术比较,其可使长程持续性房颤患者获益。

Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation:Mid-long term result of a randomized controlled trial

Objective To evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation.Methods In this study,108 patients with all long-standing persistent atrial fibrillation(LSPAF)received thoracoscopic epicardial ablation(TEA)after enrollment.There were 82 males and 26 females at age of 56.5±9.4 years.After blanking-period,patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation(HA)group(50 patients)and a TEA group(58 patients).Only patients in the HA group received catheter ablation after randomization subsequently.In at least two-year observation period,cardiovascular risk factors were observed in all groups’patients.Results The mean follow-up duration was 17.3-41.8(26.9±6.1)months and there was no significant difference between two groups8.2-40.6(27.5±5.7)months in the HA group and 17.3-41.8(26.4±6.7)months in the TEA group].The off antiarrhythmic agents(AADs)sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6,12,24 and 36 months96.0%,90.0%,83.7%,83.7%versus 79.3%,75.9%,67.3%,63.1%,HR=0.415(95%CI 0.206-0.923)].Conclusion We can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone.Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation,instead of those without a supplemental ablation.