Sun Zhishan, Fan Chengming, Song Long, Zhang Hao, Jiang Zenan, Tan Haoyu, Sun Yaqin, Liu Liming
Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
Front Cardiovasc Med. 2022 Jul 15;9:931845. doi: 10.3389/fcvm.2022.931845. eCollection 2022.
The objective of this study was to observe the safety and efficacy of electrophysiological mapping following the Cox-Maze IV procedure and to investigate whether a correlation exists between recurrence of atrial fibrillation (AF) with the completeness of bidirectional electrical isolation and the inducibility of AF immediately after the Cox-Maze IV procedure.
Totally, 80 consecutive patients who suffered from aortic valve or mitral valve disease and persistent AF were randomly enrolled into the control group and electrophysiological mapping following the Cox-Maze IV group (Electrophysio-Maze group). In the Electrophysio-Maze group, patients underwent concomitant Cox-Maze procedure and following electrophysiological mapping of ablation lines in mitral isthmus, left atrial "box," and tricuspid annulus. If the bidirectional electrical isolation of tricuspid annulus ablation line is incomplete, whether to implement supplementary ablation will be independently decided by the operator. Before and after the Cox-Maze IV procedure, AF induction was performed. All patients in both groups were continuously followed-up and underwent electrocardiogram Holter monitoring after 6 months.
In total, 42 Electrophysio-Maze patients and 38 controls were enrolled. Compared with patients in the control group, there were shorter hospital stay, better cardiac remodeling changes, and higher relief from AF during the follow-up period of 6 months in the Electrophysio-Maze group. Within the Electrophysio-Maze group, the rate of incomplete the bidirectional electrical isolation of "box" ablation lines was zero, and the rate of incomplete bidirectional electrical isolation of mitral isthmus ablation line or tricuspid annulus ablation line was 23.8%. After two cases of successful complementary ablation on the tricuspid annulus ablation line, the final incomplete bidirectional electrical isolation of annulus ablation lines was 19.0%. There were correlations between late AF recurrence after 6 months with incomplete bidirectional electrical isolation of annulus ablation lines and AF induction immediately after the Cox-Maze IV procedure.
Electrophysiological mapping following the Cox-Maze procedure is safe and effective. Electrophysiological mapping in the Cox-Maze procedure can find out the non-transmural annulus ablation lines by assessing the completeness of bidirectional electrical isolation of ablation lines, guide supplementary ablation, and predict AF recurrence after 6 months.
本研究旨在观察Cox-Maze IV术后电生理标测的安全性和有效性，并探讨房颤（AF）复发与双向电隔离完整性之间是否存在相关性，以及Cox-Maze IV术后即刻AF的诱发情况。
总共80例患有主动脉瓣或二尖瓣疾病并伴有持续性AF的连续患者被随机纳入对照组和Cox-Maze IV术后电生理标测组（电生理迷宫组）。在电生理迷宫组中，患者接受Cox-Maze手术及随后对二尖瓣峡部、左心房“盒状”区域和三尖瓣环消融线的电生理标测。如果三尖瓣环消融线双向电隔离不完全，是否进行补充消融由术者独立决定。在Cox-Maze IV术前和术后进行AF诱发。两组所有患者均进行连续随访，并在6个月后接受动态心电图监测。
共纳入42例电生理迷宫组患者和38例对照组患者。与对照组患者相比，电生理迷宫组患者在6个月的随访期内住院时间更短，心脏重构变化更好且AF缓解率更高。在电生理迷宫组中，“盒状”消融线双向电隔离不完全的发生率为零，二尖瓣峡部消融线或三尖瓣环消融线双向电隔离不完全的发生率为23.8%。在三尖瓣环消融线成功进行两例补充消融后，环消融线最终双向电隔离不完全率为19.0%。6个月后晚期AF复发与环消融线双向电隔离不完全以及Cox-Maze IV术后即刻AF诱发之间存在相关性。
Cox-Maze术后电生理标测安全有效。Cox-Maze手术中的电生理标测可通过评估消融线双向电隔离的完整性发现非透壁性环消融线，指导补充消融，并预测6个月后AF复发情况。
