Chen M C, Chang J P, Guo G B, Chang H W
Department of Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
J Cardiovasc Electrophysiol. 2001 Aug;12(8):867-74. doi: 10.1046/j.1540-8167.2001.00867.x.
Previous studies showed that the surgical maze procedure can restore sinus rhythm and atrial transport function in patients with chronic atrial fibrillation (AF). However, no previous studies discussed the association of atrial size reduction and the success of sinus conversion by the radiofrequency (RF) maze procedure for chronic AF.
A total of 119 chronic AF patients undergoing valvular operations were included in this study. Sixty-one patients received RF and cryoablation to create lesions in both atria to simulate the surgical maze II or III procedure (RF maze II or RF maze III; 13 patients, group 1) or a modified maze pattern (RF maze "IV"; 48 patients, group 2). The other 58 patients who underwent valvular operations alone without the maze procedure served as control (group 3). At 3-month follow-up after operation, sinus rhythm was restored in 73%, 81%, and 11% of patients in groups 1, 2 and 3, respectively. Preoperative left and right atrial sizes were not statistically significant predictors of sinus conversion by the RF maze procedure. However, as a result of postoperative reduction of atrial sizes, postoperative left atrial diameter was significantly smaller in patients who had sinus conversion by the RF maze procedure than in patients who did not regain sinus rhythm (45.0+/-7.0 mm vs 51.0+/-8.0 mm; P = 0.03). Postoperative right atrial area of patients who had sinus conversion by the RF maze procedure also was significantly smaller than that of patients who did not regain sinus rhythm (18.1+/-4.4 cm2 vs 28.5+/-8.2 cm2; P = 0.008).
Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery.
既往研究表明，手术迷宫术可恢复慢性心房颤动（房颤）患者的窦性心律和心房传输功能。然而，既往尚无研究探讨心房大小缩小与慢性房颤射频（RF）迷宫术窦性心律转复成功之间的关联。
本研究共纳入119例行瓣膜手术的慢性房颤患者。61例患者接受RF和冷冻消融在双心房制造损伤，以模拟手术迷宫II或III术式（RF迷宫II或RF迷宫III；13例患者，第1组）或改良迷宫模式（RF迷宫“IV”；48例患者，第2组）。另外58例仅接受瓣膜手术而未行迷宫术的患者作为对照（第3组）。术后3个月随访时，第1组、第2组和第3组患者的窦性心律恢复率分别为73%、81%和11%。术前左、右心房大小并非RF迷宫术窦性心律转复的统计学显著预测因素。然而，由于术后心房大小缩小，RF迷宫术窦性心律转复成功的患者术后左心房直径显著小于未恢复窦性心律的患者（45.0±7.0 mm对51.0±8.0 mm；P = 0.03）。RF迷宫术窦性心律转复成功的患者术后右心房面积也显著小于未恢复窦性心律的患者（18.1±4.4 cm²对28.5±8.2 cm²；P = 0.008）。
心房大小缩小似乎可预测与瓣膜手术联合应用的RF迷宫术窦性心律转复的成功。
