Lawrie G M, Lin H T, Wyndham C R, DeBakey M E
Ann Surg. 1987 Jun;205(6):700-11. doi: 10.1097/00000658-198706000-00012.
Over 6 years, recurrent drug-refractory supraventricular arrhythmias were treated by electrophysiologically guided surgical procedures in 67 patients. There were 57 patients, age 10-72 years, with accessory pathways who had 61 operations. The perioperative mortality rate was 3.5%, with deaths occurring in two patients with complex problems. Four patients with multiple but one or more silent accessory pathways had successful reoperation, and modified surgical technique has eliminated this problem. All patients are free of arrhythmias 2-70 months after operation. The survival and primary cure rates were 100% for 36 patients with solitary accessory pathways. Eight patients, age 10-53 years, were operated on for atrial focal tachycardia. Right atrial cryothermic lesions without excision or cardiopulmonary bypass were used in four patients: local excision was used in two patients and combined procedures were used in two patients. Because of recurrence in two of four patients treated by isolated cryoablation, a new technique was applied subsequently to one of these patients and two other patients: wide atrial excision and PTFE patch replacement during cardiopulmonary bypass. All patients are free of arrhythmias at a follow-up of 9-72 months. Intractable atrial flutter or fibrillation occurred in 11 patients who had 15 attempts at transvenous A-V node electroshock ablation. In three patients in whom this failed, subsequent open cryoablation of the A-V node during cardiopulmonary bypass and epicardial pacemaker implantation were performed successfully. Two patients had A-V nodal modification for control of A-V nodal re-entry tachycardia: one patient with cryothermia at the time of ablation of atrial focal tachycardia and the other patient with sharp dissection at the time of accessory pathway division. Of the initial 67 patients, 65 (97%) survived operation and all were cured of their presenting arrhythmia. Surgery for drug-refractory supraventricular arrhythmias is safe and effective in selected cases.
在6年多的时间里，67例药物难治性室上性心律失常患者接受了电生理指导下的外科手术治疗。57例年龄在10至72岁之间、患有旁路的患者接受了61次手术。围手术期死亡率为3.5%，2例有复杂问题的患者死亡。4例有多条但一条或多条隐匿性旁路的患者再次手术成功，改良的手术技术已消除了这一问题。所有患者术后2至70个月均无心律失常。36例孤立性旁路患者的生存率和初步治愈率均为100%。8例年龄在10至53岁之间的患者因房性局灶性心动过速接受了手术。4例患者采用右心房低温消融术，未进行切除或体外循环：2例患者采用局部切除术，2例患者采用联合手术。由于4例单纯冷冻消融治疗的患者中有2例复发，随后对其中1例患者和另外2例患者应用了新技术：体外循环期间广泛心房切除及聚四氟乙烯补片置换术。所有患者在9至72个月的随访中均无心律失常。11例患者进行了15次经静脉房室结电击消融术，发生了顽固性心房扑动或颤动。其中3例失败，随后在体外循环期间成功进行了房室结开放冷冻消融术并植入心外膜起搏器。2例患者进行了房室结改良以控制房室结折返性心动过速：1例在房性局灶性心动过速消融时采用冷冻疗法，另1例在旁路分离时采用锐性解剖。最初的67例患者中，65例（97%）术后存活，所有患者的现有心律失常均得到治愈。在选定的病例中，药物难治性室上性心律失常的手术治疗是安全有效的。
