Tsai Feng-Chun, Ho Heng-Tsan, Chang Jen-Ping, Tsai Feng-Chang, Chu Jaw-Ji, Lin Pyng-Jing
Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University of Medicine, Kwei-Shan, Taoyuan, Taiwan; Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan.
PLoS One. 2015 Jun 11;10(6):e0126300. doi: 10.1371/journal.pone.0126300. eCollection 2015.
Traditional Cox maze III is the gold standard for treatment of atrial fibrillation (AF). Because of its invasiveness, it has been replaced by a simplified procedure involving radiofrequency ablation of modified Cox maze IV. Although the modified Cox maze IV has the advantages of simplicity and less morbidity, a lower rate of sinus rhythm conversion has been reported. We try to establish a scoring system to predict the outcome of this procedure.
The derivation group consisted of 287 patients with structural heart disease and chronic AF who underwent cardiac surgery and modified Cox-maze IV procedure between August 2005 and March 2013. Demographics, clinical and laboratory variables were retrospectively collected as sinus conversional predictors. Overall sinus conversion rate was 75.8%. The parameters of the Soft Markers Scoring system included AF duration, preoperative left atrial (LA) size, rheumatic pathology and postoperative LA remodeling. We compared 80 patients from another hospital between January 2004 and December 2011 as a validation group to evaluate the power of the scoring system. Soft Markers Score indicated a good discriminative power by using the areas under the receiver operating characteristic curve (AUROC: 0.759 ± 0.032). The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively.
In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.
传统的Cox迷宫III手术是治疗心房颤动（AF）的金标准。由于其具有侵入性，已被一种简化的手术方法所取代，该方法涉及对改良Cox迷宫IV进行射频消融。尽管改良Cox迷宫IV具有操作简单和发病率较低的优点，但据报道其窦性心律转复率较低。我们试图建立一种评分系统来预测该手术的结果。
推导组由287例患有结构性心脏病和慢性房颤的患者组成，这些患者在2005年8月至2013年3月期间接受了心脏手术和改良Cox迷宫IV手术。回顾性收集人口统计学、临床和实验室变量作为窦性转复预测指标。总体窦性转复率为75.8%。软指标评分系统的参数包括房颤持续时间、术前左心房（LA）大小、风湿性病变和术后LA重塑。我们将2004年1月至2011年12月期间来自另一家医院的80例患者作为验证组，以评估该评分系统的效能。软指标评分通过使用受试者操作特征曲线下面积显示出良好的判别能力（曲线下面积：0.759±0.032）。该评分进一步分为三组：低（0 - 2分）、中（3 - 5分）和高（6 - 10分），预测的窦性转复率分别为92.4%、74.2%和47.8%。
在接受改良Cox迷宫IV手术的慢性房颤患者中，软指标评分在我们的患者中显示出良好的预测窦性恢复的判别能力，并且在其他验证人群中也适用良好。
