Wu Chia-Chen, Chang Jen-Ping, Chen Mien-Cheng, Cheng Cheng-I, Chung Wen-Jung
Division of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.
Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.
J Thorac Dis. 2017 Dec;9(12):5176-5183. doi: 10.21037/jtd.2017.11.112.
The radiofrequency (RF) maze procedure can effectively restore sinus rhythm in most patients with persistent atrial fibrillation (AF) and mitral disease. However, long-term results and predictors for late AF recurrence are still under investigation.
From December 1995 to November 2011, 207 consecutive patients with persistent AF and mitral disease underwent RF maze procedure and concomitant mitral surgery. The mean age was 54±12.4 year-old. Mitral surgery was performed in all patients and concomitant procedures including tricuspid surgery, aortic valve surgery, and atrial septal defect closure were carried on 164 patients.
The in-hospital mortality was 3.9% (n=8) and late mortality was 8.2% (n=17). After a mean follow-up period of 101±50.9 months, 154 patients (74.4%) had long-term sinus conversion. A permanent pacer was implanted in 8 patients (3.9%). By Cox multivariate survival regression analysis, predictors for long-term sinus conversion were identified to be the duration of persistent AF, preoperative left atrial (LA) diameter, preoperative right atrial (RA) area, and preoperative beta-blocker use. The receiver operating characteristic (ROC) curve analysis showed that the best cutoff value for persistent AF duration, preoperative LA diameter, and preoperative RA area were 59.5 months, 59.85 mm, and 25.65 cm.
Longer persistent AF duration, larger preoperative LA diameter, larger preoperative RA area and preoperative beta-blocker use were the predictors for negative long-term outcome of RF maze procedure for the patients with persistent AF underwent concomitant mitral surgery. Timely referral of patients for surgery is mandatory.
射频（RF）迷宫手术可有效恢复大多数持续性心房颤动（AF）合并二尖瓣疾病患者的窦性心律。然而，长期结果以及晚期房颤复发的预测因素仍在研究中。
1995年12月至2011年11月，207例持续性AF合并二尖瓣疾病患者连续接受了RF迷宫手术及同期二尖瓣手术。平均年龄为（54±12.4）岁。所有患者均接受了二尖瓣手术，164例患者还进行了包括三尖瓣手术、主动脉瓣手术和房间隔缺损封堵在内的同期手术。
住院死亡率为3.9%（n = 8），晚期死亡率为8.2%（n = 17）。平均随访101±50.9个月后，154例患者（74.4%）实现了长期窦性心律转复。8例患者（3.9%）植入了永久性起搏器。通过Cox多因素生存回归分析，确定长期窦性心律转复的预测因素为持续性AF的持续时间、术前左心房（LA）直径、术前右心房（RA）面积和术前β受体阻滞剂的使用情况。受试者工作特征（ROC）曲线分析显示，持续性AF持续时间、术前LA直径和术前RA面积的最佳截断值分别为59.5个月、59.85 mm和25.65 cm²。
对于接受同期二尖瓣手术的持续性AF患者，RF迷宫手术长期预后不良的预测因素为持续性AF持续时间较长、术前LA直径较大、术前RA面积较大以及术前使用β受体阻滞剂。必须及时将患者转诊进行手术。
