Cardiology Department, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Europace. 2023 Feb 8;25(1):137-145. doi: 10.1093/europace/euac102.
Atrial tachycardias (ATs) frequently develop after a surgical Maze procedure. We aimed to elucidate the electrophysiologic mechanisms and their arrhythmogenic substrates of these ATs.
We retrospectively reviewed 20 patients (14 females, mean age of 55.5 ± 8.6 years) with post-Maze ATs who underwent high-resolution mapping at three institutions. The slow conduction areas, reentry circuits, voltage signals, complex electrograms, and their correlation with the surgical incisions and lesions placed in the surgical Maze procedures were analyzed. Thirty-six ATs with a mean cycle length of 260.0 ± 67.6 ms were mapped in these patients. Among them, 22 (61.1%) were anatomical macro-reentrant ATs (AMAT), 12 (33.3%) non-AMATs (localized ATs), and 2 (5.6%) focal ATs, respectively. Epicardial conduction bridges were observed in 6/20 (30.0%) patients and 7/36 (19.4%) ATs. Different arrhythmogenic substrates were identified in these ATs, including slow conduction regions within the previous lesion areas or between the incisions and anatomical structures, the prolonged activation pathways caused by the short lesions connecting the tricuspid annulus, and the circuits around the long incisions and/or lesions.
Reentry is the main mechanism of the post-Maze ATs. The pro-arrhythmic substrates are most likely caused by surgical incisions and lesions. The slow conduction regions and the protected channels yielded from these areas are the major arrhythmogenic factors.
迷宫手术后常发生房性心动过速（ATs）。我们旨在阐明这些 AT 的电生理机制及其心律失常基质。
我们回顾性分析了 3 家医疗机构的 20 例（女性 14 例，平均年龄 55.5±8.6 岁）迷宫手术后发生 AT 的患者。分析了慢传导区、折返环路、电压信号、复杂电图及其与手术切口和迷宫手术中放置的病变的相关性。在这些患者中，共对 36 种平均周长为 260.0±67.6ms 的 AT 进行了映射。其中，22 例（61.1%）为解剖学大折返性 AT（AMAT），12 例（33.3%）为非 AMAT（局灶性 AT），2 例（5.6%）为局灶性 AT。在 6/20（30.0%）例患者和 7/36（19.4%）例 AT 中观察到心外膜传导桥。这些 AT 存在不同的致心律失常基质，包括既往病变区或切口与解剖结构之间的慢传导区、连接三尖瓣环的短病变引起的延长激活途径，以及长切口和/或病变周围的环路。
折返是迷宫手术后 AT 的主要机制。促心律失常基质很可能是由手术切口和病变引起的。慢传导区和这些区域产生的保护通道是主要的致心律失常因素。
