Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
Ann Thorac Surg. 2019 Aug;108(2):443-450. doi: 10.1016/j.athoracsur.2019.01.088. Epub 2019 Mar 27.
Atrial fibrillation (AF) is a common cause of tachycardia-induced cardiomyopathy (TIC). This study evaluated the outcomes of the Cox-Maze IV procedure in patients with TIC and significant left ventricular dysfunction.
Between January 2002 and January 2017, 37 consecutive patients with a left ventricular ejection fraction (LVEF) of 0.40 or less underwent stand-alone surgical ablation of AF. After dilated and ischemic cardiomyopathies were excluded, 34 of 37 patients met the criteria for the diagnosis of TIC.
Patients were a mean age of 56 ± 11 years, and 24 (70%) had long-standing persistent AF. The median AF duration was 72 months (interquartile range, 9 to 276 months). Seventeen patients (50%) had at least one catheter-based ablation that failed. Mean LVEF was 0.32 ± 0.08. There were 11 patients (32%) with New York Heart Association Functional Classification III/IV symptoms. There was one (3%) 30-day mortality caused by a pulmonary embolus, despite full anticoagulation. At 12 months, freedom from atrial tachyarrhythmias on or off antiarrhythmic drugs was 94% and 89%, respectively. Postoperative echocardiograms were available for 27 of 33 patients (82%). The LVEF improved to a mean of 0.55 ± 0.08 (95% confidence interval, 0.51 to 0.58; p < 0.001). Of the 11 patients with New York Heart Association Functional Classification III/IV symptoms, 8 patients were in class I/II at the last follow-up (p = 0.02).
Restoration of sinus rhythm with the Cox-Maze IV was associated with significant improvement in the LVEF in patients with AF and TIC. This retrospective study illustrates the efficacy of the Cox-Maze IV in this patient population both at restoring sinus rhythm and improving ventricular function. Patients with TIC and poor left ventricular function in whom other treatments have failed should be strongly considered for surgical ablation.
心房颤动（AF）是心动过速性心肌病（TIC）的常见原因。本研究评估了 Cox-Maze IV 手术在 TIC 合并左心室收缩功能障碍患者中的治疗结局。
2002 年 1 月至 2017 年 1 月期间，连续 37 例左心室射血分数（LVEF）小于等于 0.40 的患者接受了孤立性房颤手术消融。在排除扩张型和缺血性心肌病后，37 例患者中有 34 例符合 TIC 的诊断标准。
患者平均年龄为 56 ± 11 岁，24 例（70%）为持续性房颤。房颤的中位时间为 72 个月（四分位间距，9 至 276 个月）。17 例（50%）患者至少有 1 次导管消融失败。平均 LVEF 为 0.32 ± 0.08。11 例（32%）患者存在纽约心功能分级 III/IV 级症状。30 天死亡率为 3%（1 例），为肺栓塞所致，尽管给予了充分抗凝治疗。术后 12 个月时，停用和继续使用抗心律失常药物时的房性心动过速无复发率分别为 94%和 89%。术后有 27 例（82%）患者的超声心动图资料可用于评估。LVEF 平均提高至 0.55 ± 0.08（95%置信区间，0.51 至 0.58；p < 0.001）。11 例纽约心功能分级 III/IV 级症状患者中，8 例在最后一次随访时心功能分级为 I/II 级（p = 0.02）。
Cox-Maze IV 恢复窦性心律与 AF 和 TIC 患者的 LVEF 显著改善相关。这项回顾性研究表明，Cox-Maze IV 手术在恢复窦性心律和改善心室功能方面对 TIC 合并左心室收缩功能障碍患者有效。对于其他治疗方法失败的 TIC 合并左心室收缩功能障碍患者，应强烈考虑手术消融。
