Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2022 Oct;70(10):908-915. doi: 10.1007/s11748-022-01820-8. Epub 2022 Apr 27.
The benefit of adding ganglionated plexi ablation to the maze procedure remains controversial. This study aims to compare the outcomes of the maze procedure with and without ganglionated plexi ablation.
This multicenter randomized study included 74 patients with atrial fibrillation associated with structural heart disease. Patients were randomly allocated to the ganglionated plexi ablation group (maze with ganglionated plexi ablation) or the maze group (maze without ganglionated plexi ablation). The lesion sets in the maze procedure were unified in all patients. High-frequency stimulation was applied to clearly identify and perform ganglionated plexi ablation. Patients were followed up for at least 6 months. The primary endpoint was a recurrence of atrial fibrillation.
The intention-to-treat analysis included 69 patients (34 in the ganglionated plexi ablation group and 35 in the maze group). No surgical mortality was observed in either group. After a mean follow-up period of 16.3 ± 7.9 months, 86.8% of patients in the ganglionated plexi ablation group and 91.4% of those in the maze group did not experience atrial fibrillation recurrence. Kaplan-Meier atrial fibrillation-free curves showed no significant difference between the two groups (P = .685). Cox proportional hazards regression analysis indicated that left atrial dimension was the only risk factor for atrial fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval 1.017-1.024, P = .019).
The addition of ganglionated plexi ablation to the maze procedure does not improve early outcome when treating atrial fibrillation associated with structural heart disease.
迷宫手术中添加神经节丛消融的益处仍存在争议。本研究旨在比较迷宫手术加与不加神经节丛消融的结果。
这项多中心随机研究纳入了 74 例伴有结构性心脏病的心房颤动患者。患者被随机分配到神经节丛消融组（迷宫加神经节丛消融）或迷宫组（迷宫不加神经节丛消融）。所有患者的迷宫手术中的消融区域都是统一的。高频刺激用于明确识别和进行神经节丛消融。患者至少随访 6 个月。主要终点是心房颤动复发。
意向治疗分析纳入了 69 例患者（神经节丛消融组 34 例，迷宫组 35 例）。两组均无手术死亡。在平均 16.3±7.9 个月的随访后，神经节丛消融组 86.8%的患者和迷宫组 91.4%的患者未发生心房颤动复发。Kaplan-Meier 心房颤动无复发生存曲线显示两组间无显著差异（P=0.685）。Cox 比例风险回归分析表明，左心房内径是心房颤动复发的唯一危险因素（风险比：1.106，95%置信区间 1.017-1.024，P=0.019）。
在治疗伴有结构性心脏病的心房颤动时，迷宫手术中添加神经节丛消融并不能改善早期结果。
