Radiofrequency Ablation Of Atrial Fibrillation By Bilateral Thoracopuncture Under Total Thoracoscopic Surgery
GAO Jie, Sr..
Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Background: Radiofrequency ablation of minimally invasive atrial fibrillation (bipulmonary vein isolation and left atrial posterior wall BOX ablation and left atrial wall nerve node ablation and martensite ligamentectomy and left atrial auricle one-time incision closure resection) under total thoracoscopic thoracic surgery and Hybrid surgery of percutaneous catheter ablation is an effective method for the treatment of continuous AF.Minimally invasive surgical approaches include unilateral thoracic cavity and bilateral thoracic cavity.Assisted thoracoscopic/total thoracoscopic or small-incision direct vision.The left atrial auricle was treated by suture and excision under direct vision.Thoracoscopic resection was performed with a one-time incision closure device and left auricular clamp was used to close the left auricular appendage.This group reported the clinical effect of bilateral thoracic wall puncture in 21 patients with AF radiofrequency under total thoracoscopy in a midterm follow-up.(Fig 1-4) Objective: To observe the incidence of complications and effect of total thoracoscopic AF radiofrequency ablation in the treatment of chronic persistent isolated AF. Methods: From April 2016 to June 2018, 21 patients (19 males, 61.9±9.1 years old, AF duration 7.2±3.3 years) with chronic persistent isolated AF were enrolled.Observation indexes: operation time, postoperative ventilator assistance time, ICU stay time, postoperative thoracic drainage volume, relevant important complications, and 24-hour Holter electrocardiogram examination at 3, 6, and 12 months after surgery were performed to analyze the operation safety and treatment effect. Results: There were no deaths in 21 patients, bilateral operation time was 215.7 ±38.1min, postoperative ventilator-assisted time was 11.4±4.7h, ICU residence time was 38.2±29.1h, postoperative thoracic drainage volume was 214.2± 121.5ml.Intraoperative sinus rate recovery: 4 cases (19.0%;4/21), 17 cases of electric defibrillation (81.0%;17/21);The mean follow-up was 11.2 + 7.9 months, and the rate of recovery from af without medication was 71.4%(15/21). After 6 months, 13 patients were exempted from warfarin anticoagulation, and the exemption rate was 61.9% (13/21).One case was converted to intercostal small incision for hemostasis due to right pulmonary vein branch tear, and one case was converted to intercostal small incision for radiofrequency and left atrial appendage resection due to left thoracic adhesion. Conclusion: Total thoracoscopic minimally invasive radiofrequency ablation is safe and effective in the treatment of chronic continuous isolated atrial fibrillation. It is an important component of Hybrid therapy for atrial fibrillation.
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