Atrial fibrillation without organic lesions (e.g., valvular disease, coronary artery disease, hyperthyroidism, etc.) is clinically referred to as isolated atrial fibrillation. Atrial fibrillation can be divided into paroxysmal (acute) and persistent (chronic) according to time: middle-aged and elderly people have paroxysmal atrial fibrillation, and those who fail to return to normal rhythm after several episodes are transformed into persistent atrial fibrillation.
Because of the loss of atrial systolic function and prolonged increase in heart rhythm in atrial fibrillation can lead to heart failure, the morbidity and mortality rate is twice as high as that of normal people. Atrial fibrillation is associated with 20% of strokes, and 35% of patients with atrial fibrillation will have one or more thromboembolisms during their lifetime.
The thrombus formed by atrial fibrillation can travel throughout the body with the blood, leading to cerebral embolism (stroke hemiparesis), arterial embolism of the limbs (requiring amputation in severe cases), intestinal artery embolism (intestinal necrosis), and renal artery embolism (hematuria, renal failure). The only drug that can effectively prevent the occurrence of thrombosis is warfarin, and long-term use requires regular blood tests in hospitals and may cause the risk of bleeding, so the prevalence of patients with atrial fibrillation in China is very low. Therefore, choosing a treatment for atrial fibrillation that can be used once and for all is currently the focus of research in the field of cardiovascular disease worldwide.
Currently, surgical treatment for AF can be divided into two categories: the traditional medical catheter interventional ablation technique and the latest surgical small-incision AF ablation procedure, with the representative technique being the thoracoscopically assisted WolfMini-maze procedure.
The differences between surgical small-incision atrial fibrillation ablation surgery and medical catheter ablation are.
1. The success rate of surgical procedures is high, close to 90%.
The technical operation is more intuitive, simple and effective than the internal catheter ablation; the ablation line is clear and accurate, and many complications can be effectively avoided.
3. 90% of the thrombus in the left atrium originates from the left atrium (the part of the left atrium that protrudes anteriorly to the right is called the left atrium), and the removal of the left atrium eliminates the risk of thrombus formation and embolism caused by atrial fibrillation, which largely avoids the occurrence of cerebral thrombosis. In contrast, the left heart ear cannot be removed by internal catheter ablation.
4. Patients do not need to experience prolonged X-ray exposure during internal catheter ablation, and there is no radiation damage.
5.The operation time is shorter than that of internal catheter ablation.
6.The cost of treatment is low, only about 60% of that of medical catheter ablation treatment.
Indications for surgical small incision minimally invasive surgical ablation for atrial fibrillation.
1, Patients aged 16 to 80 years;
2, Patients with paroxysmal and isolated atrial fibrillation;
3, Patients with obvious symptoms of atrial fibrillation, without serious organic heart disease, heart valve disease, coronary heart disease, etc. that need surgical treatment;
4.Patients who are ineffective in the treatment of antiarrhythmic drugs, or who cannot tolerate drug therapy;
5.The presence of contraindications to anticoagulation and antiplatelet therapy such as warfarin and aspirin;
6.Patients with recurrence of atrial fibrillation after endoscopic ablation;
7. Patients who cannot undergo catheter ablation in internal medicine due to the presence of thrombus or high suspicion of thrombus in the left heart ear.
It can be seen that minimally invasive cardiac surgery for atrial fibrillation is a safe, simple and effective new treatment method.