Application of minimally invasive surgical ablation in treatment of atrial fibrillation
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摘要:
目的：探讨外科微创消融治疗心房颤动（atrial fibrillation，AF）的临床效果。方法：回顾性分析南京医科大学第一附属医院行微创外科消融治疗AF患者的资料。采用Kaplan-Meier进行生存分析；采用Cox比例危险模型进行风险评估风险因素。结果：本研究总纳入245例，其中，男158例（64.5%），女87例（35.5%）；中位年龄为63.0岁。术后随访83例出现AF复发，复发比例为33.9%。与AF未复发相比，AF复发组患者有着较大的左心房内径［（40.2±5.8）mm vs. （42.3±6.0）mm，P=0.010］和左心室舒张末期内径［（46.8±4.6）mm vs. （48.0±4.3）mm，P＝0.044］。Cox回归分析结果显示，AF类型［以阵发性AF为对照，持续性和长程持续性AF HR（95%CI）=4.67（2.62~8.32），P < 0.000 1］、左心房内径［HR（95%CI）=1.05（1.00～1.10）per 1 mm，P=0.048］是外科微创房颤消融术后AF复发的危险因素。结论：对于AF患者，外科微创消融术治疗效果较为理想，术前制定外科消融策略时应当关注其危险因素，以期制定相应的保护或预防措施。
Abstract:
Objective：This stndy aims to investigate the clinical effect of minimally invasive surgical ablation in treatment of atrial fibrillation（AF）. Methods：This study retrospectively analyzed adult patients with AF treated by minimally invasive surgical ablation in the First Affiliated Hospital of Nanjing Medical University. Logistic multivariate regression was used to detect the risk factors. The Kaplan-Meier method was used to perform survival analysis. Cox proportional risk model was used to assess risk factors. Results：A total of 245 patients with AF were included in this study，including 158 males（64.5%）and 87 females（35.5%），with median age 63.0 years. The recurrence rate of AF was 33.9% in 83 cases. Compared with patients without AF recurrence，patients in the AF recurrence group had a larger left atrial［（40.2±5.8）mm vs. 42.3±6.0 mm），P=0.010］ and left ventricular end-diastolic dimension［（46.8±4.6）mm vs. （48.0±4.3）mm，P=0.044］. Cox analysis showed AF type［paroxysmal AF as the control，persistent and long-term AF HR（95%CI）=4.67（2.62~8.32），P < 0.000 1］ and left atvial ［HR（95%CI）=1.05（1.00~1.10） per 1 mm P=0.048］ were independent risk factors for AF recurrence. Conclusion：For patients with AF，minimally invasive surgical ablation is effective，and the risk factors should be paid attention to when formulating surgical ablation strategies before surgery to formulate corresponding protective or preventive measures.
