中文摘要：

目的探讨持续性心房颤动（房颤）一站式杂交手术的有效性和安全性。方法2015年5月至2016年12月河北燕达医院连续22例持续性房颤患者[男15例，女7例，平均年龄（57±9）岁，其中18例为长程持续性房颤（平均房颤持续时间6．9年）]接受一站式杂交手术。经左侧胸壁全胸腔镜途径消融两侧肺静脉、左心房后壁及Marshall韧带，并切除左心耳。之后经导管心内膜途径对外科消融径线的完整性进行验证并阻断残存传导以及进行心房的基质改良。后者的靶点包括：低振幅（〈0．3mV）心房碎裂电位区域、局部心房激动频率快于周围的区域、左心房前壁线及三尖瓣环峡部消融线。消融终点为经导管消融终止房颤。结果所有患者均实现包括两侧肺静脉在内的左心房后壁隔离及左心耳切除。术中的持续性房颤终止率为68．2％（15／22）。平均随访（12＋6）个月后，单次消融成功率为68．2％（15／22）。4例患者接受了再次导管消融，其中2例成功。最终随访成功率为77．2％（17／22）。术中房颤经消融终止者的单次消融成功率显著高于经电复律终止者（86．7％对28．5％，P=0．014）。并发症为皮下气肿和迟发性胸腔积液各1例。结论一站式杂交手术治疗长程持续性房颤安全、有效。

英文摘要：

Objective To investigate the safety and efficacy of hybrid ablation in treating persistent at- rial fibrillation （PsAF）. Methods Twenty-two consecutive patients [ 15 male,mean age：（57±9） years] who underwent one-stage hybrid ablation for PsAF （ n = 4 ） or long-standing PsAF （ n = 18, mean AF duration ： 6. 9 years ） were included. Electric isolation of bilateral pulmonary veins and posterior wall of left atrium, ablation of Ligament of Marshall and resection of left atrial appendage were performed through a complete thoracoscopic ap- proaeh via the left chest wall. The completeness of lesions created by epicardial ablation was checked by endo- cardial mapping and the conduction gaps on the lines were closed by catheter ablation. In addition,the cavotricus- pid isthmus and the areas with the following electrogram characteristics were ablated：complex fractionated atrial potentials with low voltage （〈0. 3 mV） and atrial deflections more rapid than those from the adjacent sites. The endpoint of hybrid ablation was termination of PsAF. Results Bi-lateral pulmonary veins and posterior left atrial wall isolation and left atrial appendage exclusion were achieved in all patients. During ablation, PsAF was termina- ted in 68.2% （15/22） patients. At follow-up of （12±6） months ,the success rate was 68.2% （15/22） after the index procedure and increased to 77.2% （17/22） after the repeat catheter ablation. The success rate in patients who achieved acute success was higher than that PsAF were cardioverted （86. 7% vs. 28. 5% ,P=0. 014） fi- nallg. Complications were subcutaneous emphysema in 1 patient and late pleural effusion in another. Conclusion Hybrid ablation is a safe and effective approach in treating long-standing PsAF.