Abstract
Ăvod: TorakoskopickĂĄ ablace fibrilace sĂnĂ (TARAFS) s pouĹžitĂm bipolĂĄrnĂ radiofrekvenÄnĂ energie (Medtronic Cardioblate Gemini-S) by mÄla vĂŠst k antrĂĄlnĂ izolaci plicnĂch Ĺžil (PĹ˝) a izolaci zadnĂ stÄny levĂŠ sĂnÄ (LS). ElektrofyziologickĂŠ nĂĄlezy po ablaci touto technikou ale nejsou znĂĄmy. Metody a vĂ˝sledky: U 22 pacientĹŻ s recidivou fibrilace sĂnĂ (FS) po oboustrannĂŠ TARAFS provedenĂŠ pro perzistujĂcĂ FS byla zvolena radiofrekvenÄnĂ katetrizaÄnĂ ablace s odstupem alespoĹ tĹĂ mÄsĂcĹŻ po TARAFS. VĂ˝sledky: Z 22 pacientĹŻ nebyla izolace zadnĂ stÄny LS nalezena u 15 (68,2 %) pacientĹŻ. U 12 pacientĹŻ nebyly endokardiĂĄlnÄ zjiĹĄtÄny znĂĄmky ŞådnĂŠ pĹedchozĂ ablace, u dvou pacientĹŻ byly izolovĂĄny pravĂŠ PĹ˝ a u jednoho pacienta byly izolovĂĄny levĂŠ PĹ˝. Na konci ablace byla izolace zadnĂ stÄny LS dokonÄena u vĹĄech 15 pacientĹŻ. U 18 z celkovĂ˝ch 22 pacientĹŻ bylo katetrizaÄnĂ ablacĂ dosaĹženo nevyvolatelnosti FS. ZĂĄvÄr: U znaÄnĂŠho poÄtu pacientĹŻ s recidivou FS po TARAFS nenĂ izolace plicnĂch Ĺžil ani zadnĂ stÄny LS dokonÄena a na elektroanatomickĂŠ voltĂĄĹžovĂŠ mapÄ nejsou nalezeny ŞådnĂŠ znĂĄmky pĹedchozĂ ablace, kterĂŠ by usnadnily nĂĄslednou katetrizaÄnĂ ablaci. U vÄtĹĄiny pacientĹŻ je k dosaĹženĂ nevyvolatelnosti FS kromÄ izolace zadnĂ stÄny LS nutnĂĄ dalĹĄĂ ablace.
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