vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2023-2-08VPICKEvestar-1229Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESОтдаленные результаты торакоскопического лечения фибрилляции предсердийLong-term outcomes of thoracoscopic ablation for atrial fibrillationhttps://orcid.org/0000-0001-5837-7255СтребковаЕ. Д.StrebkovaE. D.

Москва, ул. Баррикадная, д. 2/1, стр. 1

Москва, Большая Серпуховская ул., д. 27

Moscow, 2/1 Barrikadnaya str, build. 1

Moscow, 27 Bolshaya  Serpukhovskaya str.

elizabeth.strebkova@yandex.ruhttps://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Москва, ул. Баррикадная, д. 2/1, стр. 1

Москва, Большая Серпуховская ул., д. 27

Moscow, 2/1 Barrikadnaya str, build. 1

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0002-1572-3178МалышенкоЕ. С.MalishenkoE. S.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0001-7065-0250АртюхинаЕ. А.ArtyukhinaE. A.

Москва, ул. Баррикадная, д. 2/1, стр. 1

Москва, Большая Серпуховская ул., д. 27

Moscow, 2/1 Barrikadnaya str, build. 1

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0003-1395-2951ПоповВ. А.PopovV. A.

Москва, ул. Баррикадная, д. 2/1, стр. 1

Москва, Большая Серпуховская ул., д. 27

Moscow, 2/1 Barrikadnaya str, build. 1

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0001-9160-6531НовиковМ. А.NovikovM. A.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0002-9409-5164ЯловаЕ. В.YalovaE. V.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0003-3495-6898БондуркоК. Э.BondurkoK. E.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0002-9357-0998КармазановскийГ. Г.KarmazanovskyG. G.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

https://orcid.org/0000-0001-8231-6866КадыроваМ.KadirovaM.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya  Serpukhovskaya str.

ФГБОУДПО «Российская медицинская академия непрерывного профессионального образования» МЗ РФ; ФГБУ «Национальный медицинский исследовательский центр хирургии имени А.В.Вишневского» МЗ РФРоссияFederal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation; Federal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian FederationRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии имени А.В.Вишневского» МЗ РФРоссияFederal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian FederationRussian Federation2023270620233025969Copyright © Стребкова Е.Д., Ревишвили А.Ш., Малышенко Е.С., Артюхина Е.А., Попов В.А., Новиков М.А., Ялова Е.В., Бондурко К.Э., Кармазановский Г.Г., Кадырова М., 20232023Стребкова Е.Д., Ревишвили А.Ш., Малышенко Е.С., Артюхина Е.А., Попов В.А., Новиков М.А., Ялова Е.В., Бондурко К.Э., Кармазановский Г.Г., Кадырова М.Strebkova E.D., Revishvili A.S., Malishenko E.S., Artyukhina E.A., Popov V.A., Novikov M.A., Yalova E.V., Bondurko K.E., Karmazanovsky G.G., Kadirova M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1229Цель

Цель. Основной целью данной работы является анализ эффективности торакоскопического лечения (ТЛ) фибрилляции предсердий (ФП) и определение факторов риска возврата предсердных тахиаритмий после ТЛ ФП в отдаленном периоде наблюдения.

Материал и методы исследования. С января 2019 г. по декабрь 2021 г. 150-ти пациентам с симптоматической изолированной ФП (персистирующая 29,3% (n=44), длительно-персистирующая 32% (n=48) и пароксизмальная 38,7% (n=58) после неудачных катетерных аблаций была выполнена торакоскопическая аблация ФП и ампутация ушка левого предсердия. Всем пациентам в контрольные точки исследования было проведено 24-ч холтеровское мониторирование электрокардиограммы, по результатам которого оценивали эффективность процедуры.

Результаты

Результаты. Общая эффективность ТЛ ФП в отдаленном периоде наблюдения составила 72,5%. После отмены антиаритмической терапии свобода от любых предсердных тахиаритмий составила 79,2%, 70,5% и 68,9% через 6, 12 и 24 месяца, соответственно. Дополнительные катетерные аблации через 3 месяца по поводу инцизионной тахикардий, увеличивают эффективность процедуры до 82,9%. Важными факторами риска возврата аритмии после ТЛ ФП следует считать возраст пациента, длительность ФП, предшествующие катетерные аблации и диаметр левого предсердия более 40 мм.

Выводы

Выводы. Гибридный подход существенно улучшает эффективность ТЛ ФП, в частности для пациентов с непароксизмальными формами ФП. Полученные результаты требуют дальнейшего изучения данной проблемы для повышения качества ТЛ ФП и определения оптимального набора линий аблация с учетом факторов риска возврата аритмии.

The aim of this work is to analyze the effectiveness of thoracoscopic ablation (TSA) of atrial fibrillation (AF) and to define the risk factors for the return of atrial tachyarrhythmias after TSA in the long-term follow-up period.

Methods

Methods. From January 2019 to December 2021, 150 patients with symptomatic atrial fibrillation (persistent 29.3% monitoring at the control points of the study, the results of which evaluated the effectiveness of the procedure.

Results

Results. The overall efficiency of TSA in the long-term follow-up period was 72.5%. After off-antiarrhythmic drugs, freedom from any atrial tachyarrhythmias was 79.2%, 70.5% and 68.9% after 6, 12 and 24 months, respectively. Additional catheter ablations after 3 months increase the effectiveness of the procedure to 82.9%. Important risk factors for the return of arrhythmia after TSA should be considered the patient’s age, duration of AF, previous catheter ablations and the left atria diameter of more 40 mm.

Conclusion

Conclusion. The hybrid approach significantly improves the effectiveness of TSA for patients with non-paroxysmal forms of AF. The results obtained require further study of this problem in order to improve the quality of TSA and determine the optimal set of ablation lines, considering the risk factors for the return of arrhythmia.

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