| Objective: We aimed to evaluate the efficacy and safety of one-stage hybrid approach(thoracoscopic surgical ablation combined with catheter ablation)in the treatment of refractory atrial fibrillation,and preliminarily summarized the experience.Method: 21 patients with refractory atrial fibrillation(including persistent atrial fibrillation,long-standing persistent atrial fibrillation and paroxysmal atrial fibrillation with repeated failures of catheter ablation)who underwent one-stage hybrid approach in Shanghai Sixth People’s Hospital from August 2015 to January 2018 were selected,including 14 males and 7 females,with an average age of 63±11 years and a median duration of 3 years.Firstly,bilateral pulmonary veins were ablated by thoracoscopic approach through bilateral chest wall,Marshall ligament was cut off and left atrial appendage was ligated.After that,three-dimensional modeling of the left atrium was performed,and the integrity of surgical ablation pathway was verified and residual conduction was blocked by catheter endocardium pathway combined with voltage mapping.The endpoint of ablation was pulmonary vein isolation.The patients were followed up regularly at 6 months,1,2 and 3 years after operation.Result: 21 patients achieved electrical isolation of bilateral pulmonary veins.After an average of 41.7±8 months,surgery related complications occurred in 2 cases and death occurred in 3 cases.At the6 th month of follow-up,71.4%(15/21)of the patients maintained sinus rhythm,at the 1st year of follow-up,57.1%(12/21)of the patients maintained sinus rhythm,at the 2nd year of follow-up,47.6%(10/21)of the patients maintained sinus rhythm,at the 3rd year of follow-up,31.3%(5/16)of the patients maintained sinus rhythm.There were 11 cases of recurrence,including 4 cases of atrial flutter and 7 cases of atrial fibrillation.3 patients underwent re-catheter ablation and 2 patients recovered sinus rhythm.During the operation,even in the long-term follow-up,the intervention of hybrid surgery for pulmonary vein potential isolation was still thorough.The overall success rate after re-catheter ablation or cardioversion was 71.4%(15/21).One year after the hybrid approach,the mean left atrial diameter was 48.4±7 mm,and the mean left ventricular ejection fraction was 64±4%,which was improved compared with preoperative condition,but the difference was not statistically significant(P> 0.05).Conclusion: As a new type of operation,one-stage hybrid approach has solved many difficult problems that couldn’t be solved by medicine or surgery treatment separately,and has also made up for their limitations.As far as the current experience of our center is concerned,for patients with refractory atrial fibrillation,hybrid treatment has a higher success rate and fewer complications,which preliminarily proves its safety and effectiveness. |
