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Objective This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic bipolar radio-frequency ablation in the treatment of isolated paroxysmal atrial fibrillation.Methods From September 2010 to December 2016,Seventy-two consecutive patients with paroxysmal atrial fibrillation underwent video-assisted thoracoscopic bipolar radio-frequency ablation at Fuwai Hospital.There were 50 males and 22 females with an average age of(56.5 ± 10.5) years and duration of atrial fibrillation with (6.5 ± 4.8) years.45 patients had previous catheter ablation.The patients were followed up at postoperative 3 months,6 months,1 year and annually.Success of ablation was defined as sinus rhythm and no duration of ≥30 s for rapid atrial arrhythmias,including atrial fibrillation,atrial flutter or atrial tachycardia in 24 h Holter examination.Univariate and multivariate logistic regression models were used to analyze the risk factors for atrial fibrillation recurrence.Results One patient converted to sternotomy due to bleeding on operation.All patients were successfully discharged.69 patients completed follow-up,with an average follow-up of(28 ± 18)months(3-60 months).The overall success rate was 73.9％,and the success rate without antiarrhythmic drug was 62.3％.Subgroup analysis showed that the success rate was 80％ when left atrial anterior and posterior diameter(LAD) ≤40 mm,and 57.9％ when LAD ＞ 40 mm (P =0.035).Multivariate logistic regression analysis showed that LAD ＞40 mm was an independent risk factor for postoperative recurrence of atrial fibrillation.Conclusion Video-assisted thoracoscopic bipolar radiofrequency ablation is a safe and effective method for the treatment of paroxysmal atrial fibrillation,especially in patients with LAD≤40 mm.
ABSTRACT
Objective To investigate the effect of aspirin on the incidence of thromboembolism in hypertensive patients associated with paroxysmal atrial fibrillation.MethodsFour hundred hypertensive patients with paroxysmal atrial fibrillation (mean age 59 years) free of thromboembolic events were randomized assigned to receive aspirin (0.3 g/d) or placebo. Cerebral thromboembolism,including transient ischemic attack and embolism of peripheral arteries were defined as primary outcomes. Event-free survival curves were estimated by Kaplan-Meier curve. Results During 3.6 years follow-up,primary outcomes occurred in 61 patients (4.3% per year). Aspirin significantly reduced the incidence of primary outcome as compared with placebo group( 9.0% vs 21.5%,P
ABSTRACT
Objective To evaluate the effect of radiofrequency catheter ablation treament of supraventricular tachyarrhythmias on spontaneous attack of atrial fibrillation (AF) and to further discuss the electrophysiological mechanisms of AF. Methods Thirty-one patients (20 men, 11 women; mean age 54?12 years, age range 24-69 years) with supraventricular tachyarrhythmias coexisting with AF were included in the study. The mean history of the study group was 9?5 (range 1-19) years and the mean number of AF attack was 6?5 times (range 2-18). Of the 31 cases, 5 supraventricular tachyarrhythmias were electrophysiologically proven to be typical atrial flutter (AFL), 17 atrioventricular reentrant tachycardia (AVRT), 9 atrioventricular nodal reentrant tachycardia (AVNRT). Linear lesions to make bi-directional block were done in cavo-tricuspid isthmus in AFL patients, slow pathway modification in AVNRT and accessory pathway ablation in AVRT. Results After mean follow-up of 39?19 months (range 12-72), of the 31 patients, 23 had no occurrence of AF. In 3 of the 5 AFL patients, no AF occurred after ablation, but 2 still had AF occurrence, of whom one had frequent atrial premature contractions (APCs) and short runs of AF. In 26 patients with supraventricular tachycardia, 20 had no occurrence of AF after ablation. In the remaining 6, 2 had less frequent occurrence, and 4 remained the same, of whom one had hypertention with enlarged left atrium, and another had frequent APCs and short runs of atrial tachycardia. Conclusion AFL may share the same substrate with AF or may be the trigger factor of AF, and AVNRT and AVRT are only trigger factors of AF. So after successful ablation treatment of these tachycardias, no AF occurs. But in some cases, AF substrate still exists, and AF can be triggered by other trigger factors besides tachycardias mentioned above.