Nitta Takashi, Ishii Yosuke, Sakamoto Shun-Ichiro
Division of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602. Japan.
Gen Thorac Cardiovasc Surg. 2012 Jan;60(1):13-20. doi: 10.1007/s11748-011-0849-2. Epub 2012 Jan 13.
Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined.
射频消融设备的研发和应用使迷宫手术能够安全、轻松地进行，进一步实现了通过小切口开胸或胸腔镜进行非体外循环下肺静脉隔离。迷宫手术的效果包括预防中风和其他与房颤相关的并发症、改善心脏功能以及缓解症状。已根据现有证据对迷宫手术的适应证进行了讨论。肺静脉隔离已被证明对大多数阵发性房颤患者有效，可通过心内膜导管消融和微创的心外膜消融来实施。应在成功率、脑微栓塞信号的发生情况、针对持续性或长期持续性房颤所需额外消融灶的能力以及左心耳闭合情况等方面对这两种方式进行比较。由于消融不完全导致的非连续性或非透壁性传导阻滞可导致房颤复发和房性心动过速的诱发。建议术中对消融线处的传导阻滞进行验证，以预防这些并发症。对于左心房扩大的患者，减少扩大左心房的容积或进行盒状消融以隔离整个左心房后壁可能有效，但应考虑心房运输功能可能受损的情况。标测活跃的神经节丛并对其进行消融可能会改善手术效果，但应对其对房颤和自主神经活动的长期影响进行研究。
