Albåge Anders, Lindblom Dan, Insulander Per, Kennebäck Göran
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden.
Pacing Clin Electrophysiol. 2004 Feb;27(2):194-203. doi: 10.1111/j.1540-8159.2004.00410.x.
Transient sinus node dysfunction has been demonstrated by noninvasive methods following the maze procedure for atrial fibrillation (AF). However, extensive data from invasive electrophysiological studies have not been previously reported. Thirty-seven patients, mean age 54 +/- 10 years, underwent the maze (III) procedure. Electrophysiological studies with recordings of SNRT, CSNRT, AVN-ERP, point of Wenckebach block, AH, PA, and HV interval, were performed preoperatively and 6 and 15 months postoperatively. Induction of atrial flutter/AF was attempted postoperatively. Based on electrophysiological study evaluation, the maze (III) procedure did not cause permanent damage to the sinus node in any patient with a documented normal sinus node function preoperatively (CSNRT max 541 +/- 210 vs 587 +/- 437 ms, P = 0.26). Postoperative AV node function was normal in all patients with a documented normal AV node function before surgery. One patient had an iatrogenic third degree AV block. There was no difference in PA or HV interval after surgery. Sustained atrial tachyarrhythmias could be induced in 5 patients, of whom 4 developed permanent AF/atrial flutter late after surgery. At late follow-up, (mean 45 months), 27 (73%) patients were in sinus rhythm, 5 (13%) patients had permanent pacing, and 5 patients had recurrent AF requiring His bundle ablation (n = 2) or medical treatment (n = 3). Based on electrophysiological studies, the maze (III) procedure does not cause permanent damage to the sinus or AV nodes or to the right atrial and His-Purkinje conduction systems. Electrophysiological study evaluation may predict the need for postoperative pacemaker. Induction attempts of atrial arrhythmias may predict future recurrences and guide therapeutic efforts.
在房颤（AF）迷宫手术后，非侵入性方法已证实存在短暂性窦房结功能障碍。然而，此前尚未有侵入性电生理研究的广泛数据报道。37例平均年龄54±10岁的患者接受了迷宫（III）手术。术前以及术后6个月和15个月进行了电生理研究，记录了窦房结恢复时间（SNRT）、校正窦房结恢复时间（CSNRT）、房室结有效不应期（AVN-ERP）、文氏阻滞点、AH、PA和HV间期。术后尝试诱发房扑/房颤。根据电生理研究评估，迷宫（III）手术在术前窦房结功能记录正常的任何患者中均未对窦房结造成永久性损害（CSNRT最大值541±210 vs 587±437毫秒，P = 0.26）。所有术前房室结功能记录正常的患者术后房室结功能均正常。1例患者发生医源性三度房室传导阻滞。术后PA或HV间期无差异。5例患者可诱发持续性房性快速心律失常，其中4例在术后晚期发生永久性房颤/房扑。在晚期随访（平均45个月）时，27例（73%）患者为窦性心律，5例（13%）患者进行了永久性起搏，5例患者复发性房颤需要行希氏束消融术（n = 2）或药物治疗（n = 3）。基于电生理研究，迷宫（III）手术不会对窦房结或房室结以及右心房和希氏-浦肯野传导系统造成永久性损害。电生理研究评估可预测术后起搏器的需求。房性心律失常的诱发尝试可预测未来复发情况并指导治疗措施。
