Gelsomino Sandro, Lozekoot Pieter, La Meir Mark, Lorusso Roberto, Lucà Fabiana, Rostagno Carlo, Renzulli Attilio, Parise Orlando, Matteucci Francesco, Gensini Gian Franco, Crjins Harry J G M, Maessen Jos G
University Hospital Maastricht, The Netherlands; Careggi Hospital, Florence Italy.
University Hospital Maastricht, The Netherlands.
Int J Cardiol. 2015 Aug 1;192:40-8. doi: 10.1016/j.ijcard.2015.04.259. Epub 2015 May 1.
We investigated the role of surgical ablation targeting the autonomous nervous system during a Cox-Maze IV procedure in the maintenance of sinus rhythm at long-term follow-up.
The patient population consisted of 519 subjects with persistent or long-standing persistent atrial fibrillation (AF) undergoing radiofrequency Maze IV during open heart surgery between January 2006 and July 2013 at three institutions without (Group 1) or with (Group 2) ganglionated plexi (GP) ablation. Recurrence of atrial fibrillation off-antiarrhythmic drugs was the primary outcome. Predictors of AF recurrence were evaluated by means of competing risk regression. Median follow-up was 36.7 months.
The percentage of patients in normal sinus rhythm (NSR) off-antiarrhythmic drugs did not differ between groups (Group 1-75.5%, Group 2-67.8%, p = 0.08). Duration of AF ≥ 38 months (p = 0.01), left atrial diameter ≥ 54 mm (0.001), left atrial area ≥ 33 cm(2) (p = 0.005), absence of connecting lesions (p= 0.04), and absence of right atrial ablation (p < 0.001) were independently associated with high incidence of AF recurrence. In contrast the absence of GP ablation was not a significant factor (p = 0.12).
GP ablation did not prove to be beneficial for postoperative stable NSR. A complete left atrial lesion set and biatrial ablation are advisable for improving rhythm outcomes. Randomized controlled trials are necessary to confirm our findings.
我们研究了在Cox迷宫IV手术中针对自主神经系统进行手术消融在长期随访中维持窦性心律的作用。
患者群体包括519例持续性或长期持续性心房颤动（AF）患者，于2006年1月至2013年7月在三家机构接受心脏直视手术期间进行射频迷宫IV手术，其中一组（第1组）未进行（神经节丛）（GP）消融，另一组（第2组）进行了GP消融。停用抗心律失常药物后房颤复发是主要结局。通过竞争风险回归评估房颤复发的预测因素。中位随访时间为36.7个月。
停用抗心律失常药物后处于正常窦性心律（NSR）的患者百分比在两组之间无差异（第1组-75.5%，第2组-67.8%，p = 0.08）。房颤持续时间≥38个月（p = 0.01）、左心房直径≥54 mm（0.001）、左心房面积≥33 cm²（p = 0.005）、无连接性病变（p = 0.04）以及未进行右心房消融（p < 0.001）与房颤复发的高发生率独立相关。相比之下，未进行GP消融不是一个显著因素（p = 0.12）。
GP消融并未证明对术后稳定的NSR有益。为改善心律结局，建议进行完整的左心房病变集和双心房消融。需要进行随机对照试验来证实我们的发现。
