Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Thorac Cardiovasc Surg. 2014 Mar;147(3):956-9. doi: 10.1016/j.jtcvs.2013.02.027. Epub 2013 Mar 8.
Cut-and-sew maze with a box lesion around the pulmonary veins is currently the criterion standard procedure for surgical ablation of atrial fibrillation. Recently, we changed our technique from standard bilateral epicardial pulmonary vein isolation with interconnecting lesions to a box lesion procedure with a bipolar radiofrequency ablation device. Our study describes this technique.
Between March 2009 and June 2012, we performed 90 ablations by the box technique with a bipolar radiofrequency device. Fifty-five patients (61%) had persistent atrial fibrillation, and 21 (23%) had long-standing persistent atrial fibrillation. The left atriotomy was performed along the interatrial septum and the left atrial appendage amputated. The box was made by connecting the left atriotomy to the base of the amputated appendage with lines along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar radiofrequency ablation device. The left atrial isthmus was ablated by cryoprobe.
There were no ablation-related complications. The box was easy to perform, with no dissection around the pulmonary veins. At 6-month, 1-year, and 2-year follow-ups, 80 (94%), 69 (93%), and 47 (91%) patients, respectively, were in sinus rhythm. Freedoms from antiarrhythmic medications in patients in sinus rhythm at 6 months, 1 year, and 2 years were 78%, 88%, and 85%, respectively.
The box lesion provided excellent freedom from atrial fibrillation and may improve transmurality through ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. With the box lesion, dissection around the pulmonary veins is unnecessary.
围绕肺静脉的“裁剪与缝合”迷宫术目前是房颤外科消融的金标准。最近，我们改变了技术，从标准的双侧心外膜肺静脉隔离术加连接性损伤，改为使用双极射频消融设备的盒式损伤术。本研究描述了这一技术。
2009 年 3 月至 2012 年 6 月，我们使用双极射频设备进行了 90 次盒式消融术。55 例（61%）患者为持续性房颤，21 例（23%）为长期持续性房颤。左心房切开术沿房间隔进行，并切除左心耳。通过心外膜和心内膜应用双极射频消融设备，在沿横窦和斜窦的线上将左心房切开与切除的左心耳基底连接，制作盒式结构。左心房峡部采用冷冻探针消融。
无消融相关并发症。盒式结构易于操作，且肺静脉周围无夹层。在 6 个月、1 年和 2 年随访时，分别有 80 例（94%）、69 例（93%）和 47 例（91%）患者维持窦性心律。在窦性心律的患者中，分别有 78%、88%和 85%在 6 个月、1 年和 2 年内无抗心律失常药物治疗。
盒式损伤提供了极好的房颤无复发率，并且可能通过消融 1 而非 2 层心房壁来提高透壁性，就像在心外膜肺静脉隔离术那样。使用盒式损伤，无需进行肺静脉周围的剥离。
