Gillinov A Marc, Bakaeen Faisal, McCarthy Patrick M, Blackstone Eugene H, Rajeswaran Jeevanantham, Pettersson Gosta, Sabik Joseph F, Najam Farzad, Hill Kathleen M, Svensson Lars G, Cosgrove Delos M, Marrouche Nassir, Natale Andrea
Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2006 Jan;81(1):19-26; discussion 27-8. doi: 10.1016/j.athoracsur.2005.04.060.
It is unknown whether pulmonary vein isolation or a complete Cox-Maze procedure is needed to ablate paroxysmal atrial fibrillation in patients with mitral valve disease. Our objective was to assess the impact of different surgical treatments for this arrhythmia in patients undergoing mitral valve surgery.
From July 1993 to January 2004, 152 patients underwent combined surgical treatment of paroxysmal atrial fibrillation and mitral valve disease. Ablation procedures included pulmonary vein isolation alone (n = 31, 20%), pulmonary vein isolation with left atrial connecting lesions (n = 80, 53%), and Cox-Maze (n = 41, 27%). The latter had longer durations of atrial fibrillation than the former (p < 0.0001). Rhythm documented on 1,225 postoperative electrocardiograms was used to estimate prevalence of, and risk factors for, atrial fibrillation across time. Ablation failure was defined as occurrence of atrial fibrillation any time beyond 6 months after operation.
Prevalence of postoperative atrial fibrillation peaked at 22% at 2 weeks and declined to 9% at 1 year. Risk factors included older age (p = 0.09), larger left atrium (p = 0.05), and rheumatic (p = 0.003) and degenerative etiologies (p = 0.03). Freedom from ablation failure was 84% at one year. Ablation procedure did not affect prevalence of atrial fibrillation or incidence of ablation failure.
Pulmonary vein isolation alone may be adequate treatment for patients with paroxysmal atrial fibrillation undergoing mitral valve surgery, particularly when it is of short duration. A randomized trial is necessary to examine this strategy, especially in patients with longer duration of paroxysmal atrial fibrillation.
二尖瓣疾病患者阵发性房颤消融时，是需要肺静脉隔离还是完整的Cox迷宫手术尚不清楚。我们的目的是评估二尖瓣手术患者中不同手术治疗对这种心律失常的影响。
1993年7月至2004年1月，152例患者接受了阵发性房颤与二尖瓣疾病的联合手术治疗。消融手术包括单纯肺静脉隔离（n = 31，20%）、肺静脉隔离加左心房连接部病变（n = 80，53%）以及Cox迷宫手术（n = 41，27%）。后者房颤持续时间长于前者（p < 0.0001）。利用1225份术后心电图记录的节律来评估不同时间房颤的发生率及危险因素。消融失败定义为术后6个月后任何时间出现房颤。
术后房颤发生率在2周时达到峰值22%，1年时降至9%。危险因素包括年龄较大（p = 0.09）、左心房较大（p = 0.05）、风湿性病因（p = 0.003）和退行性病因（p = 0.03）。1年时无消融失败的比例为84%。消融手术不影响房颤发生率或消融失败发生率。
对于接受二尖瓣手术的阵发性房颤患者，尤其是房颤持续时间短的患者，单纯肺静脉隔离可能是充分的治疗方法。有必要进行一项随机试验来研究这一策略，特别是对于阵发性房颤持续时间较长的患者。
