cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2021-36-2-107-114cardiotomsk-1198Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESСравнительная эффективность и безопасность биатриальной и левопредсердной аблации в хирургическом лечении длительно персистирующей формы фибрилляции предсердий при сопутствующем аортокоронарном шунтировании у больных ишемической болезнью сердцаComparative efficacy and safety of biatrial versus left atrial ablation in the surgical treatment of long-standing persistent atrial fibrillation with concomitant coronary artery bypass grafting in patients with ischemic heart diseaseКалыбековаА. Т.KalybekovaA. T.

Калыбекова Айзада Тынычбековна, аспирант, стажер-исследователь, центр хирургии аорты, коронарных и периферических артерий

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Aizada T. Kalybekova, Postgraduate Student, Research Assistant, Center for Aortic, Coronary, and Peripheral Artery Surgery

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

aizadakt@gmail.comhttps://orcid.org/0000-0003-3877-3853РахмоновС. С.RakhmonovS. S.

Рахмонов Сардор Собирович, канд. мед. наук, младший научный сотрудник, центр хирургии аорты, коронарных и периферических артерий

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Sardor S. Rakhmonov, Cand. Sci. (Med.), Junior Research Scientist, Center of Aortic, Coronary, and Peripheral Artery Surgery

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

Sardor5507@mail.ruhttps://orcid.org/0000-0002-3411-508XЛукиновВ. Л.LukinovV. L.

Лукинов Виталий Леонидович, канд. физ.-мат. наук, старший научный сотрудник, лаборатория численного анализа стохастических дифференциальных уравнений

630090, Российская Федерация, Новосибирск, пр. акад. Лаврентьева, 6

Vitaly L. Lukinov, Senior Research Scientist, Laboratory of Numerical Analysis of Stochastic Differential Equations

6, ac. Lavrentieva ave., Novosibirsk, 630090, Russian Federation

vitaliy.l.lukinov@sci-boost.comhttps://orcid.org/0000-0001-9818-8678ЧернявскийА. М.ChernyavskyiA. M.

Чернявский Александр Михайлович, д-р мед. наук, профессор, ведущий научный сотрудник, центр хирургии аорты, коронарных и периферических артерий; директор

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Alexander M. Chernyavskyi, Dr. Sci. (Med.), Professor, Leading Research Scientist, Center for Aortic, Coronary, and Peripheral Artery Surgery; Director

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

amchern@mail.ruНациональный медицинский исследовательский центр имени академика Е.Н. Мешалкина Министерства здравоохранения Российской ФедерацииРоссияMeshalkin National Medical Research CenterRussian FederationНациональный медицинский исследовательский центр имени академика Е.Н. Мешалкина Министерства здравоохраненияРоссияMeshalkin National Medical Research CenterRussian FederationИнститут вычислительной математики и математической геофизики СО РАНРоссияInstitute of Computational Mathematics and Mathematical Geophysics of the Siberian Branch of Russian Academy of SciencesRussian Federation202101072021362107114Copyright © Калыбекова А.Т., Рахмонов С.С., Лукинов В.Л., Чернявский А.М., 20212021Калыбекова А.Т., Рахмонов С.С., Лукинов В.Л., Чернявский А.М.Kalybekova A.T., Rakhmonov S.S., Lukinov V.L., Chernyavskyi A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1198Цель

Цель: сравнить результаты одномоментной биатриальной (БА) и левопредсердной (ЛПА) хирургической аблации предсердий, проводимой у пациентов с длительно персистирующей формой фибрилляции предсердий (ФП) с сопутствующей ишемической болезнью сердца (ИБС), требующей аортокоронарного шунтирования (АКШ).

Материал и методы

Материал и методы. Проспективное рандомизированное одноцентровое слепое исследование проводилось на базе Национального медицинского исследовательского центра имени академика Е.Н. Мешалкина Министерства здравоохранения Российской Федерации в период с 2016 по 2019 гг. В исследование были включены 116 пациентов с длительно персистирующей формой ФП и ИБС. В итоге 116 пациентов были рандомизированы на 2 равные группы: 58 человек (БА + АКШ), 58 человек (ЛПА + АКШ). Пациентам I группы выполняли БА предсердий, пациентам II группы – изолированную ЛПА. Обе группы подверглись операции АКШ совместно с проведением аблации предсердий (ЛПА или БА).

Результаты

Результаты. Техника БА оказалась более эффективной в сохранении синусового ритма (58%) по сравнению с изолированной ЛПА (31%) через 24 мес. (p = 0,019) после хирургического лечения длительно персистирующей формы ФП с сопутствующей АКШ.

Заключение

Заключение. Техника БА оказалась эффективней изолированной ЛПА в отдаленном послеоперационном периоде 24 мес.

Purpose

Purpose. To compare the results of biatrial (BA) and left atrial ablation (LAA) performed in patients with long-standing persistent atrial fibrillation (AF) with concomitant coronary artery disease (CAD) with indication for coronary artery bypass grafting (CABG).

Material and Methods

Material and Methods. A prospective, randomized, single-center, blinded study was conducted on the basis Meshalkin National Medical Research Center in the period from 2016 to 2019. A total of 116 patients with long-standing persistent AF and CAD were randomized into two groups: BA + CABG group (n = 58) and LAA + CABG group (n = 58). Patients of both groups underwent CABG surgery with the chosen atrial ablation technique (LAA or BA).

Results

Results: BA technique proved to be more effective in maintaining sinus rhythm (58%) compared with isolated LAA (31%) at 24 months (p = 0.019) after surgical treatment of long-standing persistent AF with concomitant CABG.

Conclusion

Conclusion: BA technique was more effective than isolated LAA in the late postoperative period of 24 months.

фибрилляция предсердийбиатриальная аблациядлительно персистирующая формаишемическая болезнь сердцаэлектрокардиостимуляторизолированная левопредсердная аблацияatrial fibrillationbiatrial ablationlong-standing persistent formischemic heart diseasepacemakerisolated left atrial ablationReferencesHindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström- Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2021;42(5):373–498. DOI: 10.1093/eurheartj/ehaa612.Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström- Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2021;42(5):373–498. DOI: 10.1093/eurheartj/ehaa612.Badhwar V., Rankin J.S., Damiano R.J. Jr., Gillinov A.M., Bakaeen F.G., Edgerton J.R. et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann. Thorac. Surg. 2017;103(1):329–341. DOI: 10.1016/j.athoracsur.2016.10.076.Badhwar V., Rankin J.S., Damiano R.J. Jr., Gillinov A.M., Bakaeen F.G., Edgerton J.R. et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann. Thorac. Surg. 2017;103(1):329–341. DOI: 10.1016/j.athoracsur.2016.10.076.Stulak J.M., Suri R.M., Burkhart H.M., Daly R.C., Dearani J.A., Greason K.L. et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze III procedure? J. Thorac. Cardiovasc. Surg. 2014;147(5):1478–1486. DOI: 10.1016/j.jtcvs.2013.10.084.Stulak J.M., Suri R.M., Burkhart H.M., Daly R.C., Dearani J.A., Greason K.L. et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze III procedure? J. Thorac. Cardiovasc. Surg. 2014;147(5):1478–1486. DOI: 10.1016/j.jtcvs.2013.10.084.Uschner D., Schindler D., Hilgers R., Heussen N. randomizeR: An R Package for the Assessment and Implementation of Randomization in Clinical Trials. Journal of Statistical Software. 2018;85(8):1–22. DOI: 10.18637/jss.v085.i08.Uschner D., Schindler D., Hilgers R., Heussen N. randomizeR: An R Package for the Assessment and Implementation of Randomization in Clinical Trials. Journal of Statistical Software. 2018;85(8):1–22. DOI: 10.18637/jss.v085.i08.Knuuti J., Wijns W., Saraste A., Capodanno D., Barbato E., Funck-Brentano C. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur. Heart J. 2020;41(3):407–477. DOI: 10.1093/eurheartj/ehz425.Knuuti J., Wijns W., Saraste A., Capodanno D., Barbato E., Funck-Brentano C. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur. Heart J. 2020;41(3):407–477. DOI: 10.1093/eurheartj/ehz425.Calkins H., Hindricks G., Cappato R., Kim Y.H., Saad E.B., Aguinaga L. et al. Document Reviewers: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–e160. DOI: 10.1093/europace/eux274.Calkins H., Hindricks G., Cappato R., Kim Y.H., Saad E.B., Aguinaga L. et al. Document Reviewers: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–e160. DOI: 10.1093/europace/eux274.Калыбекова А.Т., Чернявский А.М. Сравнительная характеристика биатриальной и левопредсердной аблации в хирургическом лечении длительно персистирующей формы фибрилляции предсердий у пациентов с сочетанной патологией сердца. Анналы аритмологии. 2019;16(4):194–203. DOI: 10.15275/annaritmol.2019.4.2.Kalybekova A.T., Chernyavskyi A.M. Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease. Annals of Arrhythmology. 2019;16(4):194–203 (In Russ.). DOI: 10.15275/annaritmol.2019.4.2.Калыбекова А.Т., Рахмонов С.С., Чернявский А.М., Алмазов А.А., Нарциссова Г.П., Мироненко С.П. Одномоментное применение хирургической радиочастотной аблации и аортокоронарного шунтирования у больных длительно персистирующей формой фибрилляции предсердий и ишемической болезнью сердца. Патология кровообращения и кардиохирургия. 2019;23(4):37–46. DOI: 10.21688/1681-3472-2019-4-37-46.Kalybekova A.T., Rahmonov S.S., Chernyavskiy A.M., Almazov A.A., Narcissova G.P., Mironenko S.P. Contemporary use of surgical radiofrequency ablation and coronary artery bypass in patients with long-standing, persistent atrial fibrillation and coronary heart disease. Circulation Pathology and Cardiac Surgery. 2019;23(4):37–46 (In Russ.). DOI: 10.21688/1681-3472-2019-4-37-46.Belley-Cote E.P., Singal R.K., McClure G., Devereaux K., Brady K., An K. et al. Perspective and practice of surgical atrial fibrillation ablation: An international survey of cardiac surgeons. Europace. 2019;21(3):445–450. DOI: 10.1093/europace/euy212.Belley-Cote E.P., Singal R.K., McClure G., Devereaux K., Brady K., An K. et al. Perspective and practice of surgical atrial fibrillation ablation: An international survey of cardiac surgeons. Europace. 2019;21(3):445–450. DOI: 10.1093/europace/euy212.Hald M.O., Lauritzen D.J., Heiberg J., Juhl W., Moss E., Vodstrup H.J. Biatrial ablation vs. Pulmonary vein isolation in atrial fibrillation patients undergoing cardiac surgery: a retrospective study. Scand. Cardiovasc. J. 2020;55(2):116–121. DOI: 10.1080/14017431.2020.1846775.Hald M.O., Lauritzen D.J., Heiberg J., Juhl W., Moss E., Vodstrup H.J. Biatrial ablation vs. Pulmonary vein isolation in atrial fibrillation patients undergoing cardiac surgery: a retrospective study. Scand. Cardiovasc. J. 2020;55(2):116–121. DOI: 10.1080/14017431.2020.1846775.Li H., Lin X., Ma X., Tao J., Zou R., Yang S. et al. Biatrial Versus Isolated Left Atrial Ablation in Atrial Fibrillation: A Systematic Review and Meta-Analysis. BioMed Res. Int. 2018;2018:3651212. DOI: 10.1155/2018/3651212.Li H., Lin X., Ma X., Tao J., Zou R., Yang S. et al. Biatrial Versus Isolated Left Atrial Ablation in Atrial Fibrillation: A Systematic Review and Meta-Analysis. BioMed Res. Int. 2018;2018:3651212. DOI: 10.1155/2018/3651212.Pecha S., Schäfer T., Yildirim Y., Ahmadzade T., Willems S., Reichenspurner H. et al. Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation. J. Thorac. Cardiovas. Surg. 2014;147(3):984–988. DOI: 10.1016/j.jtcvs.2013.03.012.Pecha S., Schäfer T., Yildirim Y., Ahmadzade T., Willems S., Reichenspurner H. et al. Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation. J. Thorac. Cardiovas. Surg. 2014;147(3):984–988. DOI: 10.1016/j.jtcvs.2013.03.012.Meng Z., Dong J., Jiang F. Biatrial ablation versus left atrial ablation with bipolar system in the surgical treatment of atrial fibrillation with mitral valve disease. Chinese Journal of Thoracic and Cardiovascular Surgery. 2014;30(1):482–485.Meng Z., Dong J., Jiang F. Biatrial ablation versus left atrial ablation with bipolar system in the surgical treatment of atrial fibrillation with mitral valve disease. Chinese Journal of Thoracic and Cardiovascular Surgery. 2014;30(1):482–485.Gualis J., Castaño M., Martínez-Comendador J.M., Marcos J.M., Martín C., Estévez-Loureiro R. et al. Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate. Arch. Cardiol. Méx. 2016;86(2):123–129. DOI: 10.1016/j.acmx.2015.09.005.Gualis J., Castaño M., Martínez-Comendador J.M., Marcos J.M., Martín C., Estévez-Loureiro R. et al. Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate. Arch. Cardiol. Méx. 2016;86(2):123–129. DOI: 10.1016/j.acmx.2015.09.005.Calo L., Lamberti F., Loricchio M. L., De Ruvo E., Colivicchi F., Bianconi L. et al. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: A prospective and randomized study. J. Am. Coll. Cardiol. 2006;47(12):2504–2512. DOI: 10.1016/j.jacc.2006.02.047.Calo L., Lamberti F., Loricchio M. L., De Ruvo E., Colivicchi F., Bianconi L. et al. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: A prospective and randomized study. J. Am. Coll. Cardiol. 2006;47(12):2504–2512. DOI: 10.1016/j.jacc.2006.02.047.Onorati F., Mariscalco G., Rubino A.S., Serraino F., Santini F., Musazzi A. et al. Impact of lesion sets on mid-term results of surgical ablation procedure for atrial fibrillation. J. Am. Coll. Cardiol. 2011;57(8):931–940. DOI: 10.1016/j.jacc.2010.09.055.Onorati F., Mariscalco G., Rubino A.S., Serraino F., Santini F., Musazzi A. et al. Impact of lesion sets on mid-term results of surgical ablation procedure for atrial fibrillation. J. Am. Coll. Cardiol. 2011;57(8):931–940. DOI: 10.1016/j.jacc.2010.09.055.Albage A., Peterffy M., Kallner G. Learning what works in surgical cryoablation of atrial fibrillation: Results of different application techniques and benefits of prospective follow-up. Interact. Cardiovasc. Thorac. Surg. 2011;13(5):480–484. DOI: 10.1510/icvts.2011.280735.Albage A., Peterffy M., Kallner G. Learning what works in surgical cryoablation of atrial fibrillation: Results of different application techniques and benefits of prospective follow-up. Interact. Cardiovasc. Thorac. Surg. 2011;13(5):480–484. DOI: 10.1510/icvts.2011.280735.McCarthy P.M., Kruse J., Shalli S., Ilkhanoff L., Goldberger J.J., Kadish A.H. et al. Where does atrial fibrillation surgery fail? Implications for increasing effectiveness of ablation. J. Thorac. Cardiovacs. Surg. 2010;139(4):860–867. DOI: 10.1016/j.jtcvs.2009.12.038.McCarthy P.M., Kruse J., Shalli S., Ilkhanoff L., Goldberger J.J., Kadish A.H. et al. Where does atrial fibrillation surgery fail? Implications for increasing effectiveness of ablation. J. Thorac. Cardiovacs. Surg. 2010;139(4):860–867. DOI: 10.1016/j.jtcvs.2009.12.038.Soni L.K., Cedola S.R., Cogan J., Jiang J., Yang J., Takayama H. et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J. Thorac. Cardiovacs. Surg. 2013;145(2):356–363. DOI: 10.1016/j.jtcvs.2012.09.091.Soni L.K., Cedola S.R., Cogan J., Jiang J., Yang J., Takayama H. et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J. Thorac. Cardiovacs. Surg. 2013;145(2):356–363. DOI: 10.1016/j.jtcvs.2012.09.091.Kim J.B., Bang J.H., Jung S.H., Choo S.J., Chung C.H., Lee J.W. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann. Thorac. Surg. 2011;92(4):1397–1404. DOI: 10.1016/j.athoracsur.2011.05.066.Kim J.B., Bang J.H., Jung S.H., Choo S.J., Chung C.H., Lee J.W. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann. Thorac. Surg. 2011;92(4):1397–1404. DOI: 10.1016/j.athoracsur.2011.05.066.Breda J.R., Breda A.N.C.R., Ragognette R.G., Machado L.N., Neff C.B., de Matos L.L. et al. Comparison of uniatrial and biatrial radiofrequency ablation procedures in atrial fibrillation: Initial results. Heart Surg. Forum. 2011;14(5):E271–E275. DOI: 10.1532/HSF98.20101119.Breda J.R., Breda A.N.C.R., Ragognette R.G., Machado L.N., Neff C.B., de Matos L.L. et al. Comparison of uniatrial and biatrial radiofrequency ablation procedures in atrial fibrillation: Initial results. Heart Surg. Forum. 2011;14(5):E271–E275. DOI: 10.1532/HSF98.20101119.Geuzebroek G.S.C., Ballaux P.K.E.W., Van Hemel N.M., Kelder J.C., Defauw J.A.M.T. Medium-term outcome of different surgical methods to cure atrial fibrillation: Is less worse? Interact. Cardiovasc. Thorac. Surg. 2008;7(2):201–206. DOI: 10.1510/icvts.2007.159889.Geuzebroek G.S.C., Ballaux P.K.E.W., Van Hemel N.M., Kelder J.C., Defauw J.A.M.T. Medium-term outcome of different surgical methods to cure atrial fibrillation: Is less worse? Interact. Cardiovasc. Thorac. Surg. 2008;7(2):201–206. DOI: 10.1510/icvts.2007.159889.Cappabianca G., Ferrarese S., Tutino C., Corazzari C., Matteucci M., Mantovani V. et al. Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation. J. Cardiovasc. Electrophysiol. 2019;30(10):2150–2163. DOI: 10.1111/jce.14117.Cappabianca G., Ferrarese S., Tutino C., Corazzari C., Matteucci M., Mantovani V. et al. Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation. J. Cardiovasc. Electrophysiol. 2019;30(10):2150–2163. DOI: 10.1111/jce.14117.

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