emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2025.9.2.2587emcardio-318Research ArticleОригинальные научные публикацииOriginal Scientific ResearchГибридные технологии в лечении непароксизмальных форм фибрилляции предсердийChasnoyt. Results of hybrid technology in the treatment of non-paroxysmal atrial fibrillationЖигалковичА. С.ZhigalkovichA. S.

г. Минск, ул. Р. Люксембург, 110Б, 220036

Minsk, R. Luxemburg street, 110B, 220036

kardio@tut.byЖмайликР. Р.ZhmaylikR. R.

г. Минск, ул. Р. Люксембург, 110Б, 220036

Minsk, R. Luxemburg street, 110B, 220036

kardio@tut.byЧаснойтьА. Р.ChasnoytA. R.

г. Минск, ул. Р. Люксембург, 110Б, 220036

Minsk, R. Luxemburg street, 110B, 220036

kardio@tut.byГУ «Республиканский научно-практический центр «Кардиология»State Institution “Republican Scientific and Practical Center “Cardiology”2025250120269225872598Copyright © Жигалкович А.С., Жмайлик Р.Р., Часнойть А.Р., 20262026Жигалкович А.С., Жмайлик Р.Р., Часнойть А.Р.Zhigalkovich A.S., Zhmaylik R.R., Chasnoyt A.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/318

На основании анализа непосредственных и отдаленных результатов лечения рандомизированной когорты пациентов с идиопатической непароксизмальной фибрилляцией предсердий показана безопасность и эффективность миниинвазивной биатриальной эпикардиальной биполярной радиочастотной абляции как в формате гибридного лечения в сочетании с эндокардиальной абляцией устьев легочных вен, так и в автономном варианте.

Цель

Цель: оценить эффективность гибридного и этапного лечения идиопатической персистирующей фибрилляции предсердий (ФП) путем анализа непосредственных и долгосрочных (2 года) результатов лечения в рамках одноцентрового рандомизированного клинического контролируемого исследования.

Материалы и методы

Материалы и методы. В одноцентровое рандомизированное исследование были включены 33 пациента с непароксизмальной формой ФП. Всем пациентам в качестве первой процедуры выполнялась миниинвазивная видеоассистированная эпикардиальная радиочастотная абляция (РЧА) согласно патенту на изобретение Республики Беларусь № 22432 от 06.12.2016 г. «Способ биполярной миниинвазивной эпикардиальной радиочастотной абляции у пациентов с изолированной персистирующей фибрилляцией предсердий». В зависимости от распределения группы пациент получал процедуру эндокардиальной абляции либо в текущую госпитализацию, либо в период 3–6 месяцев после эпикардиального этапа в случае рецидива предсердной аритмии (ФП/ТП). К первичным конечным точкам относились частота рецидива ФП на госпитальном этапе, частота удержания синусового ритма (СР) на момент окончания госпитализации, потребность в постоянном ЭКС, частота больших кардио и цереброваскулярных событий (МАССЕ). Вторичные конечные точки включали удержание СР на момент окончания наблюдения, необходимость приема ААП I/III класса и антикоагулянтов за пределами «слепого» периода, а также необходимость в повторных процедурах.

Результаты

Результаты. По первичным конечным точкам различий в результатах между группами не отмечено. К моменту выписки из стационара синусовый ритм (СР) имел место у 100 % пациентов. Больших кардиоваскулярных и цереброваскулярных событий на госпитальном этапе мы не наблюдали. Пароксизмы ФП на период завершения исследования у пациентов с использованием ААТ I/III классов наблюдаются в группе «гибридного» в 2 (13,33 %) случаев и 2 (11,1 %) в группе «этапного» лечения. Потребность в повторных процедурах по поводу предсердной аритмии составила в группе «гибридного» лечения в 2 (13,3 %) случаях и 5 (27,78 %) в группе «этапного» лечения. Кумулятивный показатель удержания СР в среднесрочном периоде в течение 1 года составил 94,5 % в обеих группах, спустя 2 года в группе «гибридного» лечения этот показатель составил 86,7 %, а в группе «этапного» – 88,9 %.

Заключение

Заключение. Эпикардиальная биполярная биатриальная абляция показала высокую эффективность в лечении непароксизмальных форм ФП, однако нередко требует проведения повторных процедур по устранению типичного ТП. Для выполнения более эффективной изоляции ЛВ целесообразно выполнять раздельную устьевую абляцию легочных вен в дополнение к антральной. Этапное лечение персистирущих форм ФП оправдано с клинической и экономической точки зрения.

Based on the analysis of immediate and long-term results of treatment of a randomized cohort of patients with idiopathic non-paroxysmal atrial fibrillation, the safety and effectiveness of minimally invasive biatrial epicardial bipolar radiofrequency ablation both in the format of hybrid treatment in combination with endocardial ablation of pulmonary veins and in a stand-alone variant have been shown.

Aim

Aim: To evaluate the effectiveness of hybrid and staged treatment of idiopathic persistent atrial fibrillation (AF) by analyzing immediate and long-term (2 years) treatment results in a single-center randomized clinical controlled trial.

Methods

Methods. A single-center randomized trial included 33 patients with non-paroxysmal AF. All patients underwent minimally invasive video-assisted epicardial radiofrequency ablation (RFA) as the first procedure in accordance with Patent for invention of the Republic of Belarus № 22432 dated 12.06.2016. "The method of bipolar minimally invasive epicardial radiofrequency ablation in patients with isolated persistent atrial fibrillation". Depending on the distribution of the group, the patient received an endocardial ablation procedure either during the current hospitalization, or in the period 3-6 months after the epicardial stage in case of recurrence of atrial arrhythmia (Atrial Fibrillation/Atrial Flutter). The primary endpoints included the frequency of AF recurrence at the hospital stage, the frequency of sinus rhythm retention (SR) at the end of hospitalization, the need for pacemakers, the frequency of major adverse cardioand cerebrovascular events (MACCE). Secondary endpoints included retention of SR at the end of observe, the need to take class I/III antiarrhythmic drugs (AAD) and anticoagulants outside the "blind" period, as well as the need for repeated procedures.

Results

Results. There were no differences in the results between the groups for the primary endpoints. By the time of discharge from the hospital, sinus rhythm (SR) occurred in 100 % of patients. We did not observe major adverse cardiovascular and cerebrovascular events at the hospital stage. AF paroxysms at the end of the study period in patients using class I/III AAD were observed in 2 (13.33 %) cases in the "hybrid" group and 2 (11.1 %) cases in the "staged" treatment group. The need for repeated procedures for atrial arrhythmias was 2 (13.3 %) cases in the "hybrid" treatment group and 5 (27.78 %) cases in the "staged" treatment group. The cumulative mid-term SR retention rate at 1 year was 94.5 % in both groups; after 2 years, the rate was 86.7 % in the "hybrid" treatment group and 88.9 % in the "staged" group.

Conclusion

Conclusion. Epicardial bipolar biatrial ablation has shown high efficacy in the treatment of non-paroxysmal forms of AF, but often requires repeated procedures to eliminate typical atrial flutter. To perform more effective pulmonary veins isolation, it is reasonable to perform separate pulmonary vein ablation in addition to antral ablation. The staged treatment of persistent forms of AF is justified from the clinical and economic point of view.

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