Purpose

Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA.

Methods

Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m². Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up.

Results

At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4–62.8] ml/m²), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m²). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8–49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8–47.4 in a combined group of GLA and/or female sex(log rank p = 0.02).

Conclusion

Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.

中文翻译：

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左心房极度扩大患者的胸腔镜手术心房颤动消融术

目的

肺静脉隔离 (PVI) 对心房颤动 (AF) 的疗效随着左心房 (LA) 体积的增加而降低。然而，正在对巨大 LA (GLA) 患者进行疗效未知的手术 AF 消融。我们确定了与没有 GLA 的患者相比，胸腔镜 AF 消融的疗效。

方法

患者接受了胸腔镜 PVI 和额外的左心房消融线（持续性 AF），并进行了前瞻性随访。GLA 定义为 LA 体积指数 (LAVI) ≥ 50 ml/m ²。每 3 个月用心电图和 24 小时动态心电图进行随访。在 3 个月的空白期后，所有抗心律失常药物均停用。主要结果是在 2 年的随访期间无任何房性快速心律失常≥ 30 秒。

结果

基线时，68 名 (15.4%) 患者有 GLA (LAVI: 56.7 [52.4–62.8] ml/m ² )，而 374 (84.6%) 名患者有较小的 LA (LAVI: 34.8 [29.2–41.3] ml/m ²）。GLA 患者年龄较大（61.9 ± 6.9 vs 59.4 ± 8.8 岁，p  = 0.02），更常被诊断为持续性房颤（76.5% vs 58.6%，p  = 0.008）。性别分布均等（约 25% 为女性）。在 2 年的随访中，与非 GLA 患者相比，GLA 患者的复发率更高（42.6% 对 57.2%，对数秩p  = 0.02）。非 GLA 阵发性 AF 患者的 AF 自由率为 69.0%，而 GLA 和/或持续性 AF 患者的联合组为 43.8-49.3%（log rank p < 0.001)。此外，非 GLA 男性患者的自由度为 62.4%，而 GLA 和/或女性患者的自由度为 43.8-47.4（对数秩p  = 0.02）。

结论

胸腔镜 AF 消融是大部分 GLA 患者的有效治疗方法。胸腔镜 AF 消融可作为这些患者的最后治疗选择。