Hemels Martin E W, Gu Youlan L, Tuinenburg Anton E, Boonstra Piet W, Wiesfeld Ans C P, van den Berg Maarten P, Van Veldhuisen Dirk J, Van Gelder Isabelle C
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ann Thorac Surg. 2006 May;81(5):1773-9. doi: 10.1016/j.athoracsur.2005.10.007.
Rhythm control is indicated for patients suffering from symptomatic atrial fibrillation (AF), but remains difficult to establish. We investigated the long-term outcome of Cox maze III surgery in patients with symptomatic lone AF refractory to antiarrhythmic drug therapy.
Patients with a history of symptomatic paroxysmal or persistent AF refractory for at least two class I or III antiarrhythmic drugs and without structural heart disease or bradyarrhythmias were included. All patients underwent Cox maze III surgery. Complete success was defined as the absence of AF without antiarrhythmic drugs beyond 3 months after the procedure, and partial success as the absence of AF with antiarrhythmic drug use.
A total of 29 patients were included (27 male), with a mean age of 48 +/- 6 years. At the time of surgery, 11 patients (38%) had persistent AF. After a mean follow-up of 4.8 +/- 2.4 years, 79% of patients had complete success, and 2 patients (7%) were free of AF with antiarrhythmic drugs. At the end of follow-up, left ventricular fractional shortening was significantly improved (from 31% +/- 10% to 39% +/- 8%, p = 0.002), left atrial size was unchanged, exercise capacity was within normal ranges, and quality of life was comparable with that of healthy controls. Severe complications included reoperations for postoperative bleeding (n = 3), pericardial effusion (n = 1), and mediastinitis (n = 1). In 2 patients, a pacemaker was implanted postoperatively because of sinus node dysfunction.
Cox maze III surgery is a highly effective therapy for drug-refractory lone AF, and therefore remains an alternative to transvenous pulmonary vein ablation.
节律控制适用于有症状的心房颤动（AF）患者，但仍难以实现。我们研究了Cox迷宫III手术对药物治疗无效的有症状孤立性AF患者的长期疗效。
纳入有症状的阵发性或持续性AF病史、对至少两种I类或III类抗心律失常药物治疗无效、无结构性心脏病或缓慢性心律失常的患者。所有患者均接受Cox迷宫III手术。完全成功定义为术后3个月以上无抗心律失常药物时无AF，部分成功定义为使用抗心律失常药物时无AF。
共纳入29例患者（27例男性），平均年龄48±6岁。手术时，11例患者（38%）有持续性AF。平均随访4.8±2.4年后，79%的患者完全成功，2例患者（7%）使用抗心律失常药物后无AF。随访结束时，左心室缩短分数显著改善（从31%±10%提高到39%±8%，p = 0.002），左心房大小未改变，运动能力在正常范围内，生活质量与健康对照组相当。严重并发症包括术后出血再次手术（n = 3）、心包积液（n = 1）和纵隔炎（n = 1）。2例患者术后因窦房结功能障碍植入起搏器。
Cox迷宫III手术是药物难治性孤立性AF的一种高效治疗方法，因此仍是经静脉肺静脉消融的替代方法。
