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首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intra-operative device.
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Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intra-operative device.

机译：心内膜和心外膜射频消融术治疗房颤的新术中装置。

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OBJECTIVE: Atrial fibrillation has been a difficult problem to solve in many surgical patients, especially in those with mitral valve pathology. This study evaluates the results of endocardial and epicardial radiofrequency ablation with a new intra-operative device in the treatment of atrial fibrillation. METHODS: We operated on 65 patients with atrial fibrillation, 58 of which had concomitant mitral surgery. Atrial fibrillation was chronic (over 1 year) in 46 patients (group A) and paroxysmal or recent onset in 12 (group B). Group C had lone atrial fibrillation (two), concomitant coronary artery disease (four) or a sarcoma (one). Bilateral pulmonary vein isolation with a new intra-operative device was performed through multiple dry lesions in all patients. Groups A and B had endocardial applications at 70 degrees C during 60 s and group C had epicardial applications at 75 degrees C. Three group C patients had epicardial applications off pump. Atrial wall biopsies were performed in nine patients from groups A and B. RESULTS: There were no serious post-operative complications. At 1 month follow-up 54% of all patients were out of atrial fibrillation and 34% were in normal sinus rhythm with bilateral atrial contraction (Santa Crus Score 4). At 6 months follow-up, in spite of some crossover of patients among groups, similar results were obtained. The success of the procedure was 69% (Santa Crus scores 3 and 4) in mitral patients with a left atrial volume smaller than 200 cm(3). Preliminary data on the transmurality of the lesions is presented. The patients submitted to epicardial radiofrequency ablation (group C) have satisfactory results at 1 month (six out of seven were out of AF). CONCLUSIONS: Both endocardial and epicardial RF applications are simple and quick to perform and do not pose an additional risk for most patients. Furthermore we believe that it is possible to perform bilateral epicardial radiofrequency ablation of the pulmonary veins without cardiopulmonary bypass. Further refinements of the technique are needed to assure transmurality of all lesions and better results.
机译：目的：房颤一直是许多外科手术患者难以解决的问题，尤其是二尖瓣病变的患者。这项研究评估了心内膜和心外膜射频消融治疗心房颤动的新型术中设备的结果。方法：我们对65例房颤患者进行了手术，其中58例同时进行了二尖瓣手术。 46例患者（A组）为房颤为慢性（1年以上），阵发性或近期发作为12例（B组）。 C组患有单独的心房颤动（两个），伴随的冠状动脉疾病（四个）或肉瘤（一个）。在所有患者中，通过多个干性病变，采用新的术中装置进行了双侧肺静脉隔离。 A组和B组在60 s内在70摄氏度下进行心内膜应用，C组在75摄氏度下进行心外膜应用。三组C组患者在非体外循环下进行心外膜应用。 A组和B组的9例患者进行了房壁活检。结果：没有严重的术后并发症。在1个月的随访中，所有患者中54％的患者未发生房颤，而34％的患者窦性心律正常，双侧心房收缩（Santa Crus评分4）。在随访的6个月中，尽管各组患者之间有所交叉，但仍获得了相似的结果。对于二尖瓣左房容积小于200 cm的二尖瓣手术，该手术成功率为69％（Santa Crus评分3和4）。提供了有关病灶透壁性的初步数据。接受心外膜射频消融的患者（C组）在1个月时有满意的结果（七分之六来自房颤）。结论：心内膜和心外膜射频应用均简单，快速且对大多数患者没有额外的风险。此外，我们认为无需进行体外循环就可以对肺静脉进行双侧心外膜射频消融。需要进一步完善该技术以确保所有病变的透壁性和更好的结果。

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