Kharazi Alexandra L, Hernandez Frank Villa, Mounsey J Paul, Kiser Andy C
Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
Cardiovascular Services, St. Clair Hospital, Pittsburgh, PA, USA.
J Innov Card Rhythm Manag. 2020 Jan 15;11(1):3969-3974. doi: 10.19102/icrm.2020.110104. eCollection 2020 Jan.
Atrial fibrillation (AF) remains the most common cardiac dysarrhythmia, with a significant impact on the health-care economy. AF occurs as a result of electrical conduction delays within the atrial tissue, which may stem from fibrosis or other mediators that alter atrial tissue conduction substrate. The Cox maze III and IV procedures block these reentry circuits by directly dividing, or breaking, the self-perpetuating circuit and by isolating these circuits away from the intrinsic cardiac conduction pathway. The Convergent procedure, a hybrid approach to AF ablation, coordinates the electrophysiologist and the cardiac surgeon in a simultaneous or sequential endocardial and epicardial procedure. Because the heart remains electrically active, electroanatomical maps, not anatomical landmarks, guide therapy. However, lesion transmurality and contiguity remain inconsistent. The Rhythmia HDx™ mapping system (Boston Scientific, Natick, MA, USA) offers detailed maps of acute lesion patterns during the ablation procedure. However, these maps require instrumentation and technology found in the electrophysiology laboratory, not in the operating room. We herein present a case during which we performed a Cox maze IV procedure and also applied the Rhythmia HDx™ electroanatomical mapping system (Boston Scientific, Natick, MA, USA) at the time of operation. Through this novel approach, we were able to verify the completeness of the lesions created and reach a procedural endpoint confirmed by both epicardial and endocardial maps of successful electrical isolation of the left atrium posterior wall and pulmonary vein pedicle.
心房颤动（AF）仍然是最常见的心脏心律失常，对医疗保健经济有重大影响。AF是由于心房组织内的电传导延迟所致，这可能源于纤维化或其他改变心房组织传导基质的介质。Cox迷宫III和IV手术通过直接分割或破坏自我维持的电路，并将这些电路与心脏固有传导途径隔离开来，阻断这些折返电路。Convergent手术是一种用于AF消融的混合方法，它在同步或序贯的心内膜和心外膜手术中协调电生理学家和心脏外科医生。由于心脏仍保持电活动，因此电解剖图而非解剖标志指导治疗。然而，病变的透壁性和连续性仍然不一致。Rhythmia HDx™标测系统（美国马萨诸塞州纳蒂克市波士顿科学公司）可提供消融过程中急性病变模式的详细图谱。然而，这些图谱需要电生理实验室而非手术室中的仪器和技术。我们在此介绍一例在进行Cox迷宫IV手术时同时应用Rhythmia HDx™电解剖标测系统（美国马萨诸塞州纳蒂克市波士顿科学公司）的病例。通过这种新颖的方法，我们能够验证所创建病变的完整性，并达到由心外膜和心内膜图谱证实的手术终点，即成功实现左心房后壁和肺静脉蒂的电隔离。
