Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2011 Jun;91(6):1882-8; discussion 1888-9. doi: 10.1016/j.athoracsur.2011.02.035.
Catheter-based ablation is often recommended for treatment of atrial fibrillation (AF), but there are no data that directly compare late results to those of the Cox-Maze procedure. Although catheter ablation avoids operation, lack of reliable transmurality may reduce effectiveness. We compared clinical outcomes of the cut-and-sew Cox-Maze procedure with catheter ablation.
Between January 1993 and October 2007, 97 patients aged 25 to 80 years underwent an isolated cut-and-sew Cox-Maze procedure. Patients were matched 1:2 according to age, sex, and AF type, with 194 patients undergoing catheter-based ablation for lone AF.
At last follow-up, 82% of patients who underwent the Cox-Maze procedure were free of AF and had stopped taking antiarrhythmic medications compared with 55% of patients who underwent ablation (p<0.001). When analyzed as a time-related event, freedom from recurrent AF was 87% 5 years after the Cox-Maze procedure compared with 28% after catheter ablation (p<0.001). Late warfarin anticoagulation was required in 12% of patients who underwent the Cox-Maze procedure compared with 55% of patients who underwent ablation (p<0.001), and use of antiarrhythmic medications during follow-up was significantly higher in patients who underwent ablation (68% versus 15%, p<0.001). Forty-one patients (24%) required repeated ablation procedure and 9 required a second repeated ablation.
Compared with catheter-based ablation, the Cox-Maze procedure results in greater freedom from AF and less medical treatment with antiarrhythmic drugs and warfarin anticoagulation during follow-up.
导管消融术常用于治疗心房颤动（AF），但尚无直接比较两种治疗方法晚期结果的相关数据。尽管导管消融术避免了手术，但缺乏可靠的透壁性可能会降低其疗效。我们比较了切开和缝合迷宫手术与导管消融术的临床疗效。
1993 年 1 月至 2007 年 10 月，97 例年龄 25-80 岁的患者接受了单纯切开和缝合迷宫手术。根据年龄、性别和 AF 类型，按照 1:2 的比例匹配了 194 例接受导管消融术治疗孤立性 AF 的患者。
末次随访时，接受迷宫手术的患者中 82%无 AF 且停止服用抗心律失常药物，而接受消融术的患者中仅 55%（p<0.001）。分析为时间相关事件时，迷宫手术后 5 年无 AF 复发率为 87%，而消融术后为 28%（p<0.001）。接受迷宫手术的患者中有 12%需要长期华法林抗凝治疗，而接受消融术的患者中有 55%（p<0.001），且接受消融术的患者在随访期间使用抗心律失常药物的比例明显更高（68%比 15%，p<0.001）。41 例（24%）患者需要再次消融治疗，9 例患者需要第二次重复消融。
与导管消融术相比，迷宫手术在随访期间能提供更高的 AF 缓解率，更少的抗心律失常药物和华法林抗凝治疗。
