Sayed Sajid A, Katewa Ashish, Srivastava Vivek, Jana Sujit, Patwardhan Anil M
King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Sr. Registrar, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Sr. Registrar, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
Indian Heart J. 2014 Sep-Oct;66(5):510-6. doi: 10.1016/j.ihj.2014.05.010. Epub 2014 Jun 6.
Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF.
Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography.
The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05).
In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function.
心房颤动（AF）是最常见的持续性房性心律失常，发病率较高。尽管Cox迷宫III手术能治愈大多数房颤，但心房传输功能（ATF）降低仍是一个问题。从窦房结向房室环呈放射状且与心房冠状动脉平行的消融线的放射状入路，已显示出更好的ATF。
对80例患者进行单盲开放随机前瞻性研究，分为改良Cox迷宫III组和改良放射状入路组（每组40例），以评估恢复正常窦性心律（NSR）和ATF情况。对患有持续性房颤的风湿性心脏瓣膜病手术患者进行前瞻性随机分组。采用射频（RF）双极电凝创建消融线，对峡部病变和冠状窦采用冷冻消融。在6个月时比较结果，并通过超声心动图检查心房充盈分数（AFF）和A/E比值评估ATF。
通过Fisher精确检验，两组恢复NSR的比率在统计学上无显著差异（p>0.05）。与改良Cox迷宫III相比，改良放射状入路的ATF更好（未配对t检验比较A/E：0.52±0.08对0.36±0.10；p<0.05。采用Mann-Whitney U检验比较AFF：放射状组的AFF中位数为23，双房组为20；p<0.05）。
在接受风湿性心脏瓣膜手术的房颤患者中，射频放射状入路在恢复NSR方面与改良Cox迷宫III一样有效，且心房传输功能更好。
