期刊
HEART RHYTHM
卷 14, 期 9, 页码 1281-1288出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2017.04.029
关键词
Atrial fibrillation; Surgical ablation; Mini maze; Catheter ablation; Cardiac monitoring
资金
- Atricure Inc.
- Atricure Inc
- Ablation Frontiers
- Biosense Webster
- Medtronic
- Boston Scientific
- St. Jude Medical
BACKGROUND Minimally invasive surgical atrial fibrillation (AF) ablation (MISAA) delivers radiofrequency energy via a thoracoscopic approach to perform pulmonary vein isolation and left atrial ganglionic plexi ablation. Data on long-term outcomes of MISAA are lacking. OBJECTIVE We report 5-year follow-up data from a prospective cohort of patients who underwent MISAA at a single center. METHODS One hundred nine consecutive patients (60 paroxysmal, 49 persistent; mean age 62.7 +/- 9.3 years) underwent MISAA with left atrial appendage exclusion by a single surgeon between 2006 and 2012. Patients were followed with transtelephonic monitoring at 1, 6, and 12 months and annually thereafter for up to 5 years. Recurrence was defined as any atrial tachyarrhythmia lasting >= 30 seconds from 90 days after surgery onward. RESULTS Mean follow-up duration was 1738.5 +/- 661.5 days. Single-procedure success rate was 38% (37 of 98 patients). Atrial arrhythmias occurred in 22%, 42%, 55%, 59%, and 62% of patients by 1, 2, 3, 4, and 5 years. Seventy-eight (79.6%) patients remained AF free with or without additional interventions including catheter ablation, antiarrhythmic drugs, or cardioversion. There was no significant difference in AF-free survival between paroxysmal and persistent AF groups (P - .725). Multivariate analyses showed hypertension to be a significant predictor of AF recurrence (odds ratio 6.6, confidence interval 1.41-30.80; P = .016). Five (5.1%) patients had a stroke or transient ischemic attack during follow-up. CONCLUSION AF-free survival was 38% at 5 years after MISAA. A total of 79.6% of patients remained AF free with or without additional intervention. Patients may have an ongoing risk of stroke even in the absence of AF recurrences.
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