Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2023-11-16 DOI:10.1155/2023/9463793

Chunyu Yu, Haojie Li, Shuo Yuan, Lihui Zheng, Ling-min Wu, Ligang Ding, Yan Yao, Zhe Zheng

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引用次数: 0

Abstract

Background. Limited randomized controlled studies showed that thoracoscopic surgical left atrial ablation was not superior to catheter ablation (CA) in patients with persistent atrial fibrillation (PerAF). Right atrium might play an important role in triggering and maintaining atrial fibrillation (AF) in patients with PerAF. This study aimed to compare the efficacy of thoracoscopic surgical biatrial ablation versus CA in patients with PerAF. Methods. Patients with PerAF underwent thoracoscopic surgical biatrial ablation or CA were included in this study. Propensity score matching (1 : 2) was applied to select patients in CA group and surgical ablation (SA) group. The primary endpoint was to compare the probability of freedom from atrial tachyarrhythmias between SA and CA. Atrial tachyarrhythmia recurrence was defined as any atrial tachyarrhythmias longer than 30 s documented by 24-hour Holter monitoring after the 3-month blanking period. Results. After propensity score matching, 51 patients in surgical biatrial ablation group and 102 patients in CA group were enrolled (mean left atrial diameter: 45.8 mm). The probability of freedom from atrial tachyarrhythmias on antiarrhythmia drugs was 62.7%, 60.6%, and 60.6% in SA group and 42.0%, 39.6%, and 36.7% in CA group at 12, 24, and 36 months, respectively ( p = 0.011), and off antiarrhythmia drugs were 56.9%, 52.5%, and 52.5% in SA group and 36.0%, 31.4%, and 27.5% in CA group at 12, 24, and 36 months, respectively ( p = 0.007). After adjustment of age, sex, left atrial diameter, and AF duration history, multivariable Cox regression analysis suggested that SA procedure was an independent factor to reduce the risk of atrial tachyarrhythmia recurrence (HR: 0.589, 95% CI 0.370–0.937, p = 0.025). Conclusion. Compared with CA, thoracoscopic surgical biatrial ablation might achieve superior effectiveness for patients with PerAF.

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持续性心房颤动患者的胸腔镜外科双心房消融术与导管消融术比较

背景。有限的随机对照研究显示，在持续性心房颤动（PerAF）患者中，胸腔镜手术左心房消融并不优于导管消融（CA）。右心房可能在触发和维持持续性心房颤动（PerAF）患者的心房颤动（AF）中扮演重要角色。本研究旨在比较胸腔镜手术双心房消融与 CA 在 PerAF 患者中的疗效。方法。本研究纳入了接受胸腔镜手术双腔消融或 CA 的 PerAF 患者。采用倾向评分匹配法（1:2）选择 CA 组和手术消融（SA）组患者。研究的主要终点是比较 SA 和 CA 两种消融术后患者摆脱房性快速性心律失常的概率。房性快速性心律失常复发的定义是，3个月空白期后，24小时Holter监测记录到的任何超过30秒的房性快速性心律失常。结果经过倾向评分匹配后，51 名患者入选手术双心房消融组，102 名患者入选 CA 组（平均左心房直径：45.8 毫米）。12、24和36个月时，SA组患者服用抗心律失常药物后摆脱房性快速性心律失常的概率分别为62.7%、60.6%和60.6%，CA组患者分别为42.0%、39.6%和36.7%（P = 0.在12、24和36个月时，SA组停用抗心律失常药物的比例分别为56.9%、52.5%和52.5%，CA组分别为36.0%、31.4%和27.5%（P = 0.007）。在对年龄、性别、左心房直径和房颤持续时间史进行调整后，多变量考克斯回归分析表明，SA 手术是降低房性快速性心律失常复发风险的独立因素（HR：0.589，95% CI 0.370-0.937，P = 0.025）。结论与CA相比，胸腔镜外科双心房消融术对PerAF患者可能会取得更好的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.