外科迷宫手术后的心房扑动：发生率、诊断及管理
Atrial flutter after surgical maze: incidence, diagnosis, and management.
作者信息
Dresen William, Mason Pamela K
机构信息
Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA.
出版信息
Curr Opin Cardiol. 2016 Jan;31(1):57-63. doi: 10.1097/HCO.0000000000000239.
PURPOSE OF REVIEW
The prevalence of atrial fibrillation is increasing and surgical ablation is becoming more common, both as a stand-alone procedure and when performed concomitantly with other cardiac surgery. Although surgical ablation is effective, with it unique challenges arise, including iatrogenic macroreentrant tachycardias that are often highly symptomatic and difficult to manage conservatively.
RECENT FINDINGS
Postsurgical ablation, localization of the arrhythmic circuit is difficult to determine using surface ECG alone because of alterations in the atrial myocardium, and multiple different pathways are often present. Most, however, localize to the left atrium, and percutaneous catheter ablation is emerging as an effective treatment modality.
SUMMARY
Patients with complex postoperative arrhythmias should be referred to a dedicated atrial fibrillation center when possible and symptomatic arrhythmias mapped and ablated. Knowledge of the previously performed surgical lesion set is of vital importance in understanding the mechanism of the arrhythmia and increasing procedural success rates.
VIDEO ABSTRACT
综述目的
心房颤动的患病率正在上升，手术消融作为一种独立的手术以及与其他心脏手术同时进行时，正变得越来越普遍。尽管手术消融是有效的，但随之而来也出现了独特的挑战，包括医源性大折返性心动过速，这些心动过速通常症状严重且难以通过保守方法处理。
最新发现
术后消融时，由于心房心肌的改变，仅使用体表心电图很难确定心律失常环路的位置，而且通常存在多种不同的传导途径。然而，大多数心律失常环路定位于左心房，经皮导管消融正成为一种有效的治疗方式。
总结
对于术后复杂心律失常患者，应尽可能转诊至专门的心房颤动中心，对有症状的心律失常进行标测和消融。了解先前进行的手术损伤情况对于理解心律失常机制和提高手术成功率至关重要。
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