emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.1.1459emcardio-103Research ArticleОригинальные научные публикацииOriginal Scientific ResearchОтдаленные результаты миниинвазивной эпикардиальной видеоассистированной радиочастотной изоляции легочных вен при изолированной фибрилляции предсердийLong-term results of minimally invasive epicardial video-assisted radiofrequency isolation of pulmonary veins in isolated atrial fibrillationЖигалковичА. С.ZhyhalkovichA.

Минск

Minsk

ЖмайликР. Р.ZhmailikR.

Минск

Minsk

РНПЦ «Кардиология»Republican Scientific and Practical Center “Cardiology”2022270620256114591465Copyright © Жигалкович А.С., Жмайлик Р.Р., 20252025Жигалкович А.С., Жмайлик Р.Р.Zhyhalkovich A., Zhmailik R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/103

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.Результаты. В госпитальном периоде не отмечено летальных случаев, конверсий в стернотомию, неврологических осложнений. Отдаленный период изучен у 100% пациентов, средний срок наблюдения составил 7,4+0,5 года. Оценка конечного ритма осуществлялась с применением холтеровского мониторирования через 3, 6, 12 месяцев после операции, затем ежегодно. В 6 (28%) случаях у пациентов с исходной непароксизмальной ФП в разные сроки после операции выполнена эндокардиальная РЧА истмуса правого предсердия или устьев ЛВ по причине наличия трепетания предсердий (4/19%) или ФП (2/9,5%). Имплантация ЭКС потребовалась в 2-х случаях (9,0%).Эффективность биполярной антральной РЧА-изоляции ЛВ с использованием устройства Gemini X в зависимости от исходной формы ФП в отдаленном периоде: пароксизмальная – 100%, персистирующая – 66,7%, длительно персистирующая – 33,3%.Выводы. Эпикардиальная миниинвазивная биполярная антральная РЧА-изоляция ЛВ является высокоэффективным методом лечения пароксизмальных форм ФП. При непароксизмальных формах ФП необходимо расширять зону изоляции аритмогенных зон в предсердиях.

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.Results. During the hospital period, there were not no lethal cases, conversions to sternotomy, and neurological complications. The long-term period was studied in 100% of patients, the average follow-up period was 7.4+0.5 years. The final rhythm was assessed using Holter monitoring in 3, 6, and 12 months after surgery, then annually. In 6 (28%) cases in patients with initial non-paroxysmal AF, endocardial RFA of the isthmus of the right atrium or PV orifices was performed at different times after surgery due to the presence of atrial flutter (4/19%) or AF (2/9.5%). Implantation of the pacemaker was required in 2 cases (9.0%).The effectiveness of bipolar antral RFA isolation of the PV using the Gemini X device, depending on the initial form of AF in the long-term period: paroxysmal – 100%, persistent – 66.7%, long-term persistent – 33.3%.Conclusion. Epicardial minimally invasive bipolar antral PV isolation is a highly effective treatment for paroxysmal AF. In non-paroxysmal forms of AF, it is necessary to expand isolation of arrhythmogenic zones in the atria.

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The authors declare that there are no conflicts of interest present.