Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2010 Oct;25(10):1467-72. doi: 10.3346/jkms.2010.25.10.1467. Epub 2010 Sep 17.
The study aim was to compare maze outcomes using microwave ablation or cryoablation in patients with mitral disease and atrial fibrillation (AF). Between 1999 and 2005, 340 patients underwent mitral valve surgery and concomitant maze procedure involving either microwave ablation (n=96, MW group) or cryoablation (n=244, Cryo group). Mean age at operation was 50.0±12.5 yr. Follow-up period was 46.1±28.2 months. The Cryo group showed a longer aortic clamping time than the MW group (P=0.005). There were no differences in operative mortality and morbidity rates. The unadjusted 5-yr AF free rate was 61.3±1.2% in the MW group and 79.9±3.2% in the Cryo group (P=0.089). After adjustment, the MW group only showed a tendency toward more frequent AF recurrence than the Cryo group (Hazard ration 1.66, 95% confidence interval 0.89 to 3.07). Multivariate analysis revealed that older patient age (P<0.001) and greater left atrial size (P<0.001) were independent risk factors for AF recurrence. Although the use of microwave ablation results in shorter aortic clamping time, it has a tendency toward more frequent late AF recurrence than with cryoablation.
本研究旨在比较微波消融或冷冻消融治疗二尖瓣疾病合并心房颤动（AF）患者的迷宫手术结果。1999 年至 2005 年间，340 例患者接受了二尖瓣手术和同时进行的迷宫手术，其中微波消融（n=96，MW 组）或冷冻消融（n=244，Cryo 组）。手术时的平均年龄为 50.0±12.5 岁。随访期为 46.1±28.2 个月。Cryo 组的主动脉阻断时间长于 MW 组（P=0.005）。两组手术死亡率和发病率无差异。MW 组和 Cryo 组的 5 年无 AF 率分别为 61.3±1.2%和 79.9±3.2%（P=0.089）。调整后，MW 组的 AF 复发率高于 Cryo 组，但无统计学意义（风险比 1.66，95%置信区间 0.89 至 3.07）。多因素分析显示，年龄较大（P<0.001）和左心房较大（P<0.001）是 AF 复发的独立危险因素。尽管微波消融术可缩短主动脉阻断时间，但与冷冻消融术相比，晚期 AF 复发的发生率较高。
