Objectives

Surgical ablation of atrial fibrillation (AF) is recommended as a stand-alone therapy for patients refractory to medical or catheter-based treatment, or as a concomitant therapy when associated with structural disease. We report a single-therapy robotic approach to the Cox maze with longitudinal follow-up.

Methods

Consecutive patients who underwent robotic biatrial cryothermic Cox maze for nonparoxysmal AF between November 2016 and January 2022 were examined at 1, 2, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months. Freedom from atrial tachyarrhythmia was assessed with 24-hour continuous electrocardiogram or pacemaker interrogation in all patients after 6 months. Mean follow-up was 17 ± 14.5 months (range, 1-60 months). Time to event analysis with competing risks was used to determine risk-adjusted associations with late outcomes.

Results

Patients (n = 135) had a median AF duration of 4.0 years (interquartile range, 0.8-7.0), with 29.6% in whom 1 or more catheter ablations had failed. Stand-alone maze was performed in 25.2%, whereas 61.4% underwent concomitant robotic mitral valve surgery, 7.4% tricuspid valve repair, and 4.4% aortic valve replacement. No patients were discharged in AF. There were 3 operative mortalities (2.2%), none in stand-alone patients. One patient required catheter ablation at 8 months postoperatively, and one had a nonembolic stroke at 18 months. There were 9 late deaths. Freedom from atrial tachyarrhythmia and antiarrhythmic drugs at 9, 12, 18, 24, 36, and 48 months was 97.0%, 96.7%, 98.1%, 97.1%, and 100%, respectively. Lower ejection fraction and need for concomitant mitral valve replacement and/or aortic valve replacement were independently associated with worse survival.

Conclusions

For persistent AF, robotic biatrial cryothermic Cox maze offered greater than 90% 1-year longitudinal freedom from stroke, oral anticoagulation, repeat ablation, and recurrent AF without the need for antiarrhythmic drugs.

中文翻译：

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机器人辅助低温 Cox 迷宫治疗持续性心房颤动：纵向随访

目标

心房颤动 (AF) 的手术消融被推荐作为对药物或基于导管的治疗难以治愈的患者的独立疗法，或作为与结构性疾病相关时的伴随疗法。我们报告了一种针对 Cox 迷宫的单一治疗机器人方法，并进行了纵向随访。

方法

在 1、2、3、6、9、12、18、24、36、48 和 60 个月期间对在 2016 年 11 月至 2022 年 1 月期间因非阵发性 AF 接受机器人双心房低温 Cox 迷宫治疗的连续患者进行了检查。6 个月后，通过 24 小时连续心电图或起搏器检查评估所有患者是否出现房性心动过速。平均随访时间为 17 ± 14.5 个月（范围，1-60 个月）。使用具有竞争风险的事件发生时间分析来确定风险调整后与晚期结果的关联。

结果

患者 (n = 135) 的中位 AF 持续时间为 4.0 年（四分位间距，0.8-7.0），其中 29.6% 的患者 1 次或多次导管消融失败。25.2% 的患者进行了独立迷宫手术，而 61.4% 的患者同时进行了机器人二尖瓣手术、7.4% 的三尖瓣修复术和 4.4% 的主动脉瓣置换术。没有患者因房颤出院。有 3 例手术死亡 (2.2%)，独立患者中没有一例。一名患者在术后 8 个月时需要导管消融，一名患者在 18 个月时发生了非栓塞性卒中。晚期死亡9例。免于房性心动过速和抗心律失常药物在第 9、12、18、24、36 和 48 个月时，分别为 97.0%、96.7%、98.1%、97.1% 和 100%。较低的射血分数和需要同时进行二尖瓣置换术和/或主动脉瓣置换术与较差的生存率独立相关。

结论

对于持续性 AF ，机器人双心房低温 Cox 迷宫提供了超过 90% 的 1 年纵向无中风、口服抗凝药、重复消融和复发性 AF，而无需抗心律失常药物。