Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Institute of Development Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Heart Vessels. 2021 May;36(5):675-685. doi: 10.1007/s00380-020-01737-3. Epub 2021 Feb 13.
Atrial tachycardia (AT) and atrial fibrillation (AF) commonly occur after cardiac surgeries (CSs). This study investigated the mechanisms and long-term outcomes of AT and AF ablation after various Maze procedures, particularly whether atrial tachyarrhythmias after the Maze procedure occur due to gaps in the Maze lines. We analyzed 37 consecutive cases with atrial tachyarrhythmias after the Maze procedures and concomitant CSs between 2007 and 2019. Fifty-nine atrial tachyarrhythmias were induced in 37 consecutive cases, and 49 of those atrial tachyarrhythmias were mappable ATs. Forty ATs were related to the Maze procedures in the 49 mappable ATs (81.6%). All 37 consecutive cases had residual electrical conductions (gaps) in the Maze lines (88 gaps; 2.4 ± 1.2 gaps/patient). Forty of 88 gaps (45.5%) were associated with gap-related ATs. The common ATs in this study were 1. peri-mitral atrial flutter due to gaps at pulmonary vein isolation (PVI) line to mitral valve annulus (MVA) (20 cases), and 2. peri-tricuspid atrial flutter due to gaps at right atrial incision to the tricuspid valve annulus (TVA) (10 cases). Forty-seven of 49 ATs (95.9%) were successfully ablated at the first session, and there were no complications. The mean follow-up period after ablation was 3.6 ± 3.2 (median, 2.1; interquartile range, 0.89-6.84) years. The Kaplan-Meier analysis of freedom from recurrent atrial tachyarrhythmias after Maze procedure was 82.7% at 1-year follow-up and 75.5% at 4-year follow-up after a single procedure. Reentry was the main mechanism of ATs after Maze procedures and concomitant CSs, and ATs were largely related to the gaps on the Maze lines between the PVI line and the MVA or those on the lines between right atrial incision to the TVA. Long-term follow-up data suggest that catheter ablation of atrial tachyarrhythmias after various Maze procedures is effective and safe.
心房扑动(AT)和心房颤动(AF)在心脏手术后(CSs)常发生。本研究探讨了各种迷宫手术后 AT 和 AF 消融的机制和长期结果，特别是迷宫手术后出现的房性心动过速是否是由于迷宫线之间的间隙引起的。我们分析了 2007 年至 2019 年间 37 例因 CS 而行迷宫手术后出现房性心动过速的连续病例。在 37 例连续病例中诱发了 59 次房性心动过速，其中 49 次可标测到 AT。在 49 次可标测的 AT 中，有 40 次与 Maze 手术相关(81.6%)。在 37 例连续病例中，所有病例的迷宫线均存在残余电传导(间隙)(88 个间隙;每个患者 2.4±1.2 个间隙)。88 个间隙中有 40 个(45.5%)与间隙相关的 AT 相关。本研究中常见的 AT 是 1. 由于肺静脉隔离(PVI)线至二尖瓣环(MVA)的间隙引起的二尖瓣环周房扑(20 例)，2. 由于右心房切口至三尖瓣环(TVA)的间隙引起的三尖瓣环周房扑(10 例)。在第一次治疗中，49 次 AT 中的 47 次(95.9%)成功消融，无并发症。消融后平均随访时间为 3.6±3.2(中位数，2.1;四分位距，0.89-6.84)年。在单例手术治疗后，迷宫手术后房性心动过速复发的 Kaplan-Meier 分析显示，1 年随访时无复发率为 82.7%，4 年随访时为 75.5%。再入是 Maze 手术后并发 CS 后 AT 的主要机制，AT 主要与 PVI 线与 MVA 之间的迷宫线之间的间隙或右心房切口至 TVA 的线之间的间隙有关。长期随访数据表明，各种迷宫手术后房性心动过速的导管消融是有效和安全的。
