vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2021-3-5-12vestar-985Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESСреднесрочные результаты торакоскопического и гибридного лечения фибрилляции предсердийMid-term outcomes of thoracoscopic and hybrid therapy of atrial fibrillationhttps://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0002-9280-9063ТаймасоваИ. А.TaimasovaI. A.

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

irina-tame@yandex.ruhttps://orcid.org/0000-0001-7065-0250АртюхинаЕ. А.ArtyukhinaE. A.

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

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

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-7671-6652НовиковМ. В.NovikovM. V.

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-5837-7255СтребковаЕ. Д.StrebkovaE. D.

Москва, Большая Серпуховская ул. 27.

Moscow, 27 Bolshaya Serpukhovskaya str.

ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В.Вишневского» Минздрава РоссииРоссияA.V. Vishnevskiy National Medical Research Center of SurgeryRussian Federation202125102021283512Copyright © Ревишвили А.Ш., Таймасова И.А., Артюхина Е.А., Малышенко Е.С., Новиков М.В., Стребкова Е.Д., 20212021Ревишвили А.Ш., Таймасова И.А., Артюхина Е.А., Малышенко Е.С., Новиков М.В., Стребкова Е.Д.Revishvili A.S., Taimasova I.A., Artyukhina E.A., Malishenko E.S., Novikov M.V., Strebkova E.D.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/985Цель

Цель. Оценить эффективность и безопасность торакоскопической и гибридной методики у пациентов с различными формами фибрилляции предсердий (ФП).

Материал и методы

Материал и методы. Проанализированы результаты торакоскопической аблации 87 пациентов с ФП: 27 (31%) с пароксизмальной формой, 15 (17%) - с персистирующей, 45 (52%) - с длительно персистирующей формой в сроке наблюдения 18,6±6,7 мес. Воздействия по типу «Box-Lesion» и ампутация ушка левого предсердия (УЛП) выполнены у 69 (79,3%) пациентов, «Box Lesion» без ампутации УЛП у 12 (13,7%). Шести пациентам полный протокол операции выполнить не удалось в связи с техническими особенностями. При регистрации предсердной тахикардии больше 30 секунд после 3-месячного «слепого» периода пациентам выполнялось гибридное катетерное вмешательство.

Результаты

Результаты. Свобода от предсердных аритмий в группе пароксизмальной формы ФП была достигнута у 84% пациентов (21 из 25), в группе персистирующей формы - у 60% пациентов (9 из 15), в группе длительно персистирующей формы - у 78% (32 из 41) при данном сроке наблюдения. В структуре послеоперационных предсердных тахикардий рецидив ФП составил 5 (6,25%), типичное трепетание предсердий (ТП) - 3 (3,75%), атипичное левопредсердное ТП - 10 (12,5%). Средний индекс объема ЛП пациентов со стабильным синусовым ритмом составил 64,6±11,3 мл/м2 против 74,65±15,4 мл/м2 в группе предсердных тахикардий (t-критерий Стьюдента 0,53, p=0,6). Данным пациентам выполнено гибридное вмешательство. При сроке наблюдения 15,9±10,9 месяцев стабильный синусовый ритм сохранялся у 15 (83,3%) пациентов. Общий показатель интра- и послеоперационных осложнений торакоскопической аблации составил 5,7%.

Заключение

Заключение. Торакоскопический и гибридный подходы являются эффективными методами лечения различных форм ФП.

Aim

Aim. To evaluate the efficacy and safety of thoracoscopic and hybrid techniques in patients with various forms of atrial fibrillation (AF).

Methods

Methods. The results of thoracoscopic ablation of 87 patients with AF were analyzed: 27 (31%) with paroxysmal form, 15 (17%) - with persistent, 45 (52%) - with long-term persistent form at follow-up 18.6±6.7 months. “Box-Lesion” treatments and amputation of left atrial appendage (LAA) were performed in 69 (79.3%) patients, “Box Lesion” without LAA amputation in 12 (13.7%). When atrial tachycardia was recorded for more than 30 seconds after a 3-month “blind” period, patients underwent hybrid catheter intervention.

Results

Results. Freedom from atrial arrhythmias in the group of paroxysmal AF was achieved in 84% of patients (21 of 25), in the group of persistent form - in 60% of patients (9 of 15), in the group of long-term persistent form - in 78% (32 of 41) at a given observation period. In the structure of postoperative atrial tachycardia, AF recurrence was 5 (6.25%), typical atrial flutter (AFL) - 3 (3.75%), atypical AFL - 10 (12.5%). The mean LA volume index in patients with stable sinus rhythm was 64.6±11.3 ml/m2 versus 74.65±15.4 ml/m2 in the atrial tachycardia group (Student’s t-test 0.53, p = 0.6). These patients underwent a hybrid intervention. At a follow-up period of 15.9±10.9 months, a stable sinus rhythm was maintained in 15 (83.3%) patients. The overall rate of intra- and postoperative complications of thoracoscopic ablation was 5.7%.

Conclusion

Conclusion. Thoracoscopic and hybrid approaches are effective methods for various forms of AF treatment.

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