Abstract

 

OBJECTIVES

The short-term results of video-assisted thoracoscopic surgical ablation (VTSA) with box lesion have been highly variable, and the actual efficacy requires clarification through longer follow-ups. We aimed to report which patients might benefit more from VTSA with box lesion by longer follow-up.

METHODS

From September 2010 to November 2016, patients with atrial fibrillation (AF) who underwent VTSA with box lesion were screened. All enrolled patients visited the outpatient clinic and underwent 24-h Holter monitoring at 3, 6 and 12 months after surgery and annually thereafter.

RESULTS

A total of 91 consecutive patients [age, 58.0 (interquartile interval from 52.0 to 62.0) years; male, 71.4%] with paroxysmal (67%) or persistent/long-standing persistent (33%) AF were enrolled. After a median follow-up of 48 months (interquartile interval from 36 to 60 months), freedom from atrial tachyarrhythmias without antiarrhythmic drugs (AADs) was 76.5%, 66.0% and 66.0% for paroxysmal AF and 58.6%, 47.8% and 34.2% for persistent/long-standing persistent AF at 12, 36 and 60 months, respectively (P = 0.017). The preoperative left atrial diameter >40 mm (hazard ratio: 2.837, 95% confidence interval: 1.408–5.716; P = 0.004) and age >50 years (hazard ratio: 2.927, 95% confidence interval: 1.359–6.305; P = 0.006) were associated with recurrences of atrial tachyarrhythmias. In patients with paroxysmal AF and left atrial diameter ≤40 mm (n = 43), freedom from atrial tachyarrhythmias without AADs was 81.4%, 74.3% and 74.3% at 12, 36 and 60 months, respectively.

CONCLUSIONS

In patients with paroxysmal AF and left atrial diameter ≤40 mm, 5-year freedom from atrial tachyarrhythmias without AADs was 74.3%, which was better than that in patients with left atrial diameter >40 mm. A larger sample size and improved study design are needed to confirm our conclusions.

中文翻译：

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独立胸腔镜心外膜消融治疗房颤的中期结果

摘要

 

目标

带框病变的视频辅助胸腔镜手术消融（VTSA）的短期结果变化很大，实际疗效需要通过更长时间的随访来阐明。我们的目的是通过更长的随访报告哪些患者可能从 VTSA 中获益更多。

方法

2010 年 9 月至 2016 年 11 月，对接受 VTSA 并伴有箱形病变的心房颤动 (AF) 患者进行筛查。所有入组患者在手术后 3、6 和 12 个月以及此后每年都到门诊就诊并接受 24 小时动态心电图监测。

结果

总共91名连续患者[年龄，58.0（四分位距从52.0到62.0）岁；男性，71.4%] 患有阵发性 (67%) 或持续性/长期持续性 (33%) AF。中位随访 48 个月（四分位间期为 36 至 60 个月）后，无抗心律失常药物 (AADs) 的房性快速性心律失常的发生率为 76.5%、66.0% 和 66.0%，阵发性 AF 为 58.6%、47.8% 和 34.2%分别为 12、36 和 60 个月的持续性/长期持续性 AF（P  = 0.017）。术前左心房直径 > 40 mm（风险比：2.837，95% 置信区间：1.408–5.716；P  = 0.004）和年龄 >50 岁（风险比：2.927，95% 置信区间：1.359–6.305；P = 0.006) 与房性快速性心律失常的复发有关。在阵发性 AF 和左心房直径≤40 mm ( n  = 43) 的患者中，在 12、36 和 60 个月时，无 AAD 的房性快速心律失常的发生率分别为 81.4%、74.3% 和 74.3%。

结论

在阵发性 AF 且左心房直径≤40 mm 的患者中，无 AADs 的房性快速性心律失常的 5 年自由率为 74.3%，优于左心房直径 >40 mm 的患者。需要更大的样本量和改进的研究设计来证实我们的结论。