vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»vestar-654Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESСРАВНЕНИЕ РЕЗУЛЬТАТОВ КАТЕТЕРНОЙ И ХИРУРГИЧЕСКОЙ АБЛАЦИИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПОСЛЕ НЕЭФФЕКТИВНОЙ ЭНДОКАРДИАЛЬНОЙ ИЗОЛЯЦИИ ЛЕГОЧНЫХ ВЕНCOMPARATIVE ANALYSIS OF CATHETER AND SURGICAL ABLATION OF ATRIAL FIBRILLATION AFTER FAILED ENDOCARDIAL PULMONARY VEIN ISOLATIONЕлесинД. А.ElesinD. A.noemail@neicon.ruРомановА. Б.RomanovA. B.noemail@neicon.ruБогачев-ПрокофьевА. В.Bogachev-ProkofyevA. V.noemail@neicon.ruЛосикД. В.LosikD. V.noemail@neicon.ruБайрамоваС. А.BayramovaS. A.noemail@neicon.ruЯкубовА. А.YakubovA. A.noemail@neicon.ruСтрельниковА. Г.StrelnikovA. G.noemail@neicon.ruПокушаловЕ. А.PokushalovE. A.noemail@neicon.ruФГБУ «Новосибирский научно-исследовательский институт патологии кровообращения имени академика Е.Н.Мешалкина» МЗ РФRussian Federation201323092020074510Copyright © Елесин Д.А., Романов А.Б., Богачев-Прокофьев А.В., Лосик Д.В., Байрамова С.А., Якубов А.А., Стрельников А.Г., Покушалов Е.А., 20202020Елесин Д.А., Романов А.Б., Богачев-Прокофьев А.В., Лосик Д.В., Байрамова С.А., Якубов А.А., Стрельников А.Г., Покушалов Е.А.Elesin D.A., Romanov A.B., Bogachev-Prokofyev A.V., Losik D.V., Bayramova S.A., Yakubov A.A., Strelnikov A.G., Pokushalov E.A.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/654

С целью сравнения эффективности и безопасности радиочастотной (РЧ) катетерной (РЧКА) и хирургической (РЧХА) аблации в лечении пациентов с пароксизмальной (II) и персистирующей (Перс) фибрилляцией предсердий (ФП) после первичной неэффективной эндокардиальной изоляции легочных вен (ИЛВ) обследованы и прооперированы 64 пациента. В ходе РЧХА сначала выполнялось РЧ воздействие в области ганглионарных сплетений ЛВ, затем с помощью диссектора производился обход ЛВ с последующей их изоляцией с помощью биполярного зажима. Заключительным этапом выполнялось создание двух аблационных линии от правых верхней и нижней ЛВ, по куполу и нижней стенке левого предсердия (ЛП) достигая левых ЛВ. В группе РЧКА, доступ к ЛП и ЛВ был осуществлен через межпредсердную перегородку. Конечной точкой циркулярной ИЛВ явилось отсутствие электрической активности внутри изолированных ЛВ. Всем пациентам с ПерсФП в дополнение к изоляции ЛВ выполнялось создание межколлекторной линии по крыше ЛП, а также аблация митрального перешейка. Reveal XT имплантировался под кожу в левой парастернальной области. Через 12 месяцев наблюдения, у 26 (81%) из 32 пациентов в группе РЧХА отсутствовали пароксизмы ФП / трепетания предсердий / предсердных тахикардий по сравнению с 15 (47%) из 32 пациентов в группе РЧКА. Пациенты обеих групп не принимали антиаритмических препаратов. Таким образом, «видео-ассистент» РЧХА превосходит по эффективности РЧКА. Частота серьезных нежелательных явлений была выше в группе РЧХА по сравнению с РЧКА в лечении пациентов с ПФП и ПерсФП после первичной неэффективной эндокардиальной ИЛВ.

To compare effectiveness and safety of catheter and surgical radiofrequency ablation (RFA) for treatment of patients with paroxysmal and persistent atrial fibrillation (AF) after failed primary endocardial pulmonary vein isolation (PVI), 64 patients were examined and treated. In the course of surgical RFA, radiofrequency application was initially made in the area of pulmonary vein ganglionic plexuses followed by passing around pulmonary veins using a dissector, with their subsequent isolation with the aid of bipolar clamp. The final step consisted in creation of two ablation lines from the right upper and lower pulmonary veins on the left atrial dome and inferior wall reaching the left pulmonary veins. In the radiofrequency catheter ablation subjects, access to the left atrium and pulmonary veins was achieved through the inter-atrial septum. Absence of electrical activity inside isolated pulmonary veins was the endpoint of circular PVI. In all patients with persistent AF, PVI was accompanied by creation of inter-collector line on the left atrium roof, as well as the mitral isthmus ablation. The Reveal XT device was implanted subcutaneously in the left parasternal area. After 12 months of follow-up, 26 of 32 (81%) patients in the surgical RFA group were free of paroxysms AF/atrial flutter/atrial tachycardia, as opposed to 15 of 32 patients (47%) in the catheter RFA. The subjects of both groups did not take antiarrhythmics. Thus, the “video assistant” surgical RFA is more effective than catheter RFA. The incidence of serious adverse events was higher in the surgical RFA group as compared with the catheter RFA group during treatment of patients with paroxysmal and persistent AF after the failed primary endocardial PVI.

фибрилляция предсердийлевое предсердиелегочные венырадиочастотная катетерная аблацияхирургическая аблацияторакоскопиятрепетание предсердийимплантируемый кардиомониторatrial fibrillationleft atriumpulmonary veinsradiofrequency catheter ablationsurgical ablationthoracoscopyatrial flutterloop recorderReferencesCalkins H, Kuck KH, Cappato R et al. 2012 HRS/ EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design // Europace 2012; 14: 528-606.Calkins H, Kuck KH, Cappato R et al. 2012 HRS/ EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design // Europace 2012; 14: 528-606.Pokushalov E, Romanov A, Corbucci G. Ablation of paroxysmal and persistent atrial fibrillation: 1-year follow-up through continuous subcutaneous monitoring // J Cardiovasc Electrophysiol 2011; 22: 369-75.Pokushalov E, Romanov A, Corbucci G. Ablation of paroxysmal and persistent atrial fibrillation: 1-year follow-up through continuous subcutaneous monitoring // J Cardiovasc Electrophysiol 2011; 22: 369-75.Calkins H, Reynolds MR, Spector P. Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation. Two Systematic Literature Reviews and Meta-Analyses // Circ Arrhythmia Electrophysiol. 2009; 2: 349-361.Calkins H, Reynolds MR, Spector P. Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation. Two Systematic Literature Reviews and Meta-Analyses // Circ Arrhythmia Electrophysiol. 2009; 2: 349-361.Cappato R, Calkins H, Chen SA. Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation // Circ Arrhythm Electrophysiol. 2010; 3: 32-38.Cappato R, Calkins H, Chen SA. Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation // Circ Arrhythm Electrophysiol. 2010; 3: 32-38.Pokushalov E, Romanov A, Corbucci G. Use of an implantable monitor to detect arrhythmia recurrences and select patients for early repeat catheter ablation for atrial fibrillation: a pilot study.// Circ Arrhythm Electrophysiol. 2011; 4(6): 823-31.Pokushalov E, Romanov A, Corbucci G. Use of an implantable monitor to detect arrhythmia recurrences and select patients for early repeat catheter ablation for atrial fibrillation: a pilot study.// Circ Arrhythm Electrophysiol. 2011; 4(6): 823-31.Pokushalov E, Romanov A, Artyomenko S. Cry oballoon Versus Radiofrequency for Pulmonary Vein Re-Isolation After a Failed Initial Ablation Procedure in Patients with Paroxysmal Atrial Fibrillation // J Cardiovasc Electrophysiol. 2013; 24(3): 274-9.Pokushalov E, Romanov A, Artyomenko S. Cry oballoon Versus Radiofrequency for Pulmonary Vein Re-Isolation After a Failed Initial Ablation Procedure in Patients with Paroxysmal Atrial Fibrillation // J Cardiovasc Electrophysiol. 2013; 24(3): 274-9.Boersma LV, Castella M, van Boven W. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial // Circulation. 2012; 3; 125(1): 23-30.Boersma LV, Castella M, van Boven W. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial // Circulation. 2012; 3; 125(1): 23-30.Wolf R, Schneeberger E, Osterday R. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation // J Thorac Cardiovasc Surg. 2005; 130: 797-802.Wolf R, Schneeberger E, Osterday R. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation // J Thorac Cardiovasc Surg. 2005; 130: 797-802.Edgerton JR, Jackman WM, Mack MJ. A new epicardial lesion set for minimal access left atrial maze: the Dallas lesion set // Ann Thorac Surg. 2009; 88: 1655-1657.Edgerton JR, Jackman WM, Mack MJ. A new epicardial lesion set for minimal access left atrial maze: the Dallas lesion set // Ann Thorac Surg. 2009; 88: 1655-1657.Charitos EI, Stierle U, Ziegler PD. A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions // Circulation. 2012; 126: 806-814.Charitos EI, Stierle U, Ziegler PD. A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions // Circulation. 2012; 126: 806-814.Yilmaz A, Geuzebroek GS, Van Putte BP. Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation // Eur J Cardiothorac Surg. 2010; 38: 356 -360.Yilmaz A, Geuzebroek GS, Van Putte BP. Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation // Eur J Cardiothorac Surg. 2010; 38: 356 -360.Edgerton JR, Brinkman WT, Weaver T. Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach // J Thorac Cardiovasc Surg. 2010; 140: 823- 828.Edgerton JR, Brinkman WT, Weaver T. Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach // J Thorac Cardiovasc Surg. 2010; 140: 823- 828.Krul SP, Driessen AH, van Boven WJ. Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgicalelectrophysiological approach for atrial fibrillation // Circ Arrhythm Electrophysiol. 2011; 4: 262-270.Krul SP, Driessen AH, van Boven WJ. Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgicalelectrophysiological approach for atrial fibrillation // Circ Arrhythm Electrophysiol. 2011; 4: 262-270.Di Biase L, Burkhardt JD, Mohanty P. Left atrial appendage: an underrecognized trigger site of atrial fibrillation // Circulation. 2010; 122: 109 -118.Di Biase L, Burkhardt JD, Mohanty P. Left atrial appendage: an underrecognized trigger site of atrial fibrillation // Circulation. 2010; 122: 109 -118.Katritsis DG, Giazitzoglou E, Zografos T. Rapid pulmonary vein isolation combined with autonomic ganglia modification: a randomized study // Heart Rhythm. 2011; 8: 672-8.Katritsis DG, Giazitzoglou E, Zografos T. Rapid pulmonary vein isolation combined with autonomic ganglia modification: a randomized study // Heart Rhythm. 2011; 8: 672-8.Zhou Q, Hou Y, Yang S. A Meta-Analysis of the Comparative Efficacy of Ablation for Atrial Fibrillation with and without Ablation of the Ganglionated Plexi // Pacing Clin Electrophysiol. 2011; 34: 1687-94.Zhou Q, Hou Y, Yang S. A Meta-Analysis of the Comparative Efficacy of Ablation for Atrial Fibrillation with and without Ablation of the Ganglionated Plexi // Pacing Clin Electrophysiol. 2011; 34: 1687-94.Muneretto C, Bisleri G, Bontempi L. Durable staged hybrid ablation with thoracoscopic and percutaneous approach for treatment of long-standing atrial fibrillation: a 30-month assessment with continuous monitoring // J Thorac Cardiovasc Surg. 2012; 144(6): 1460-5.Muneretto C, Bisleri G, Bontempi L. Durable staged hybrid ablation with thoracoscopic and percutaneous approach for treatment of long-standing atrial fibrillation: a 30-month assessment with continuous monitoring // J Thorac Cardiovasc Surg. 2012; 144(6): 1460-5.Pison L, La Meir M, van Opstal J. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation // J Am Coll Cardiol. 2012; 3; 60(1): 54-61.Pison L, La Meir M, van Opstal J. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation // J Am Coll Cardiol. 2012; 3; 60(1): 54-61.Rostock T, O’Neill MD, Sanders P. Characterization of conduction recovery across left atrial linear lesions in patients with paroxysmal and persistent atrial fibrillation // J Cardiovasc Electrophysiol. 2006; 17: 1106-11.Rostock T, O’Neill MD, Sanders P. Characterization of conduction recovery across left atrial linear lesions in patients with paroxysmal and persistent atrial fibrillation // J Cardiovasc Electrophysiol. 2006; 17: 1106-11.

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