А.С. Жигалкович, Р.Р. Жмайлик
РНПЦ «Кардиология», г. Минск
Цель. Анализ отдаленных результатов применения миниинвазивной эпикардиальной видеоассистированной радиочастотной абляции (РЧА) легочных вен (ЛВ) у пациентов с различными формами изолированной фибрилляции предсердий (ФП).
Материалы и методы. С февраля 2011 г. по декабрь 2014 г. на базе ГУ Республиканский научно-практический центр «Кардиология» оперированы 22 пациента (муж/жен – 21/1), страдающие пароксизмальной / персистирующей / длительно персистирующей идиопатической формой ФП соответственно в 7(31,8%) / 9(41%) / 6(27,2%) случаев. Средний возраст 48,33 ± 9,37 лет (31–66). Средняя продолжительность анамнеза ФП до момента операции составила 58,6 ± 32,5 месяцев. РЧА выполнялась из билатерального миниторакотомного доступа и использованием видеоэндоскопии с применением биполярных орошаемых аблатирующих электродов-зажимов Gemini X. Всем пациентам выполнена билатеральная антральная РЧА-изоляция ЛВ. У 100% пациентов удалось достигнуть блока проведения с коллекторов ЛВ.
ключевые слова: фибрилляция предсердий, радиочастотная эпикардиальная абляция, торакоскопия.
для цитирования: А.С. Жигалкович, Р.Р. Жмайлик. Отдаленные результаты миниинвазивной эпикардиальной видеоассистированной радиочастотной изоляции легочных вен при изолированной фибрилляции предсердий. Неотложная кардиология и кардиоваскулярные риски, 2022, Т. 6, № 1, С. 1459–1465.
Long-term results of minimally invasive epicardial video-assisted radiofrequency isolation of pulmonary veins in isolated atrial fibrillation
A. Zhyhalkovich, R. Zhmailik
Aim. To analyze long-term results of the use of minimally invasive epicardial video-assisted radiofrequency ablation (RFA) of the pulmonary veins (PV) in patients with various forms of isolated atrial fibrillation (AF).
Materials and methods. Since February 2011 to December 2014, 22 patients (male/female – 21/1) with paroxysmal / persistent / long-standing persistent idiopathic form of AF were operated on the basis of the Republican Scientific and Practical Center “Cardiology”, 7 (31.8%) / 9 (41%) / 6 (27.2%) cases respectively. Mean age was 48.33 ± 9.37 (31–66) years old. The average duration of the history of AF before the operation was 58.6 ± 32.5 months. RFA was performed through a bilateral mini-thoracotomy approach using video endoscopy with the application of bipolar irrigated Gemini X ablative clamp electrodes. All patients underwent bilateral antral RFA isolation of the PVs. In 100% of patients it was possible to achieve a conduction block from the PV collectors.
keywords: atrial fibrillation, radiofrequency epicardial ablation, thoracoscopy.
for references: A. Zhyhalkovich, R. Zhmailik. Long-term results of minimally invasive epicardial video-assisted radiofrequency isolation of pulmonary veins in isolated atrial fibrillation. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2022, vol. 6, no. 1, pp. 1459–1465.
1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomstrom-Lundqvist C., Boriani G., Castella M., Dan G-A., Dilaveris P.E., Fauchier L., Filippatos G., Kalman J.M., La Meir M., Lane D.A., Lebeau J-P., Lettino M., Lip G.Y.H., Pinto F.J., Thomas G.N., Valgimigli M., Van Gelder I.C., van Putte B.P., Watkins C.L. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2021, vol. 42, no. 5, pp. 373-498. doi: 10.1093/eurheartj/ehaa612.
2. Badhwar V., Rankin J.S., Damiano Jr R.J., Gillinov A.M., Bakaeen F.G., Edgerton J.R., Philpott J.M., McCarthy P.M., Bolling S.F., Roberts H.G., Thourani V.H., Suri R.M., Shemin R.J., Firestone S., Ad N. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg, 2017, vol. 103, no 1, pp. 329-341. doi: 10.1016/j.athoracsur.2016.10.076.
3. Haïssaguerre M., Jaïs P., Shah D.C., Takahashi A., Hocini M., Quiniou G., Garrigue S., Le Mouroux A., Le Métayer P., Clémenty J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, vol. 339, no. 10, pp. 659-666. doi: 10.1056/NEJM199809033391003.
4. Zhigalkovich A.S. Miniinvazivnaya epikardial’naya ablyaciya pri fibrillyacii predserdij: evolyuciya metodov. [Minimally invasive epicardial ablation in atrial fibrillation: evolution of techniques.]. Kardiologiya v Belarusi, 2020, vol. 12, no 3, pp. 409-418. (in Russian).
5. La Meir M., Gelsomino S., Lucà F. Lorusso R., Gensini G.F., Pison L., Wellens F., Maessen J. Minimally invasive thoracoscopic hybrid treatment of lone atrial fibrillation: early results of monopolar versus bipolar radiofrequency source. Interact Cardiovasc Thorac Surg, 2012, vol. 14, no. 4, pp. 445-450. doi: 10.1093/icvts/ivr142.
6. Phan Kin, Ashleigh Xie, David H. Tian, Kasra Shaikhrezai, Tristan D. Yan (2014) Systematic review and meta-analysis of surgical ablation for atrial fibrillation during mitral valve surgery. Ann Cardiothorac Surg, no 3(1), pp. 3-14.
7. Zhigalkovich A.S. Resultati bipolarnoj miniinvasivnoj epicardialnoj radiochastotnoj ablacii u pacientov s persistiruuchej formoj fibrillacii predserdij [Results of bipolar miniinvasive epicardial radiofrequency ablation in patients with persistent atrial fibrillation]. Kardiologiya v Belarusi, 2015, no 4, pp. 27-34. (in Russian).
8. van Laar C., Kelder J., van Putte B.P. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg, 2017, vol. 24, no. 1, pp. 102-111. doi: 10.1093/icvts/ivw311.
9. Pidanov O.Yu., Tsepenshchikov V.A., Shcherbatyuk K.V., Avrusina E.K., Kolomeychenko N.A., Roslyakova I.O. (2017) Torakoskopicheskaya ablaciya v lechenii pacientov s izolirovannoj formoj fibrillyacii predserdij [Thoracoscopic ablation in the treatment of patients with lone atrial fibrillation]. Annaly aritmologii, vol. 14, no 4, pp. 190-198. (in Russian).
10. Phan K, Phan S, Thiagalingam A, Medi C, Yan TD. Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation. Eur J Cardiothorac Surg, 2016, vol. 49, no. 4, pp. 1044-1051. doi: 10.1093/ejcts/ezv180.
11. Castella M., Kotecha D., van Laar C., Wintgens L., Castillo Y., Kelder J., Aragon D., Nuñez M., Sandoval E., Casellas A., Mont L., van Boven W.J., Boersma L.V.A., van Putte B.P. Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial. Europace, 2019, vol. 21, no. 5, pp. 746-753. doi: 10.1093/europace/euy325.
12. Wang S., Liu L., Zou C. Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation: a randomized, controlled short-term trial. Chin Med J (Engl), 2014, vol. 127, no. 14, pp. 2567-2570.
13. Pokushalov E., Romanov A., Elesin D., Bogachev-Prokophiev A., Losik D., Bairamova S., Karaskov A., Steinberg J.S. Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: a randomized controlled trial. J Cardiovasc Electrophysiol, 2013, vol. 24, no. 12, pp. 1338-1343. doi: 10.1111/jce.12245.
14. Vos L.M., Kotecha D., Geuzebroek G.S.C., Hofman F.N., van Boven W.J.P., Kelder J., de Mol B.A.J.M., van Putte B.P. Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis. Europace, 2018, vol. 20, no. 11, pp. 1790-1797. doi: 10.1093/europace/eux385.
