Yano Daisuke, Tokuda Yoshiyuki, Yasuda Nao, Tsurumi Naoki, Mashiko Yuji, Kuwabara Fumiaki, Hirate Yuichi, Tajima Kazuyoshi, Mutsuga Masato
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Nagoya J Med Sci. 2025 Feb;87(1):122-132. doi: 10.18999/nagjms.87.1.122.
The Maze procedure is a well-established technique for treating atrial fibrillation; however, atrial tachyarrhythmias can recur postoperatively. This study analyzed the mechanisms of recurrence in patients who underwent electrophysiological studies and catheter ablation following the Maze procedure. Among 88 patients who underwent treatment with a modified Maze procedure, 42 developed recurrent atrial tachyarrhythmias. Among these, 18 underwent electrophysiological studies and simultaneous transcatheter radiofrequency ablation. The median period between the Maze procedure and catheter ablation was 29 months. Macro-reentrant circuits were identified in 12 patients (67%) with or without atrial fibrillation. Most patients (n = 15, 83%) had more than one conduction gap. The most frequently identified gap was around the left inferior pulmonary vein (n = 10, 56%), followed by the peri-coronary sinus area (n = 8, 44%), and the mitral isthmus area (n = 5, 28%). Catheter ablation targeting these gaps successfully eliminated tachyarrhythmias in 15 (83%) patients. At a follow-up examination 49 months after catheter ablation, 14 patients (78%) had no recurrence of tachyarrhythmia. An electrophysiological study revealed conduction gaps in patients with recurrent atrial tachyarrhythmia after the Maze procedure. Modifications to the Maze procedure should include meticulous ablation around the left inferior pulmonary vein orifice, mitral isthmus, and coronary sinus where conduction gaps frequently occur. In cases of recurrence, catheter ablation targeting the lesion effectively controlled the tachyarrhythmia.
迷宫手术是一种成熟的治疗心房颤动的技术；然而，房性快速性心律失常可在术后复发。本研究分析了接受迷宫手术后进行电生理研究和导管消融的患者复发的机制。在88例行改良迷宫手术治疗的患者中，42例出现复发性房性快速性心律失常。其中，18例接受了电生理研究并同时进行了经导管射频消融。迷宫手术与导管消融之间的中位时间为29个月。在12例（67%）有或无房颤的患者中发现了大折返环。大多数患者（n = 15，83%）有不止一个传导间隙。最常发现的间隙位于左下肺静脉周围（n = 10，56%），其次是冠状窦周围区域（n = 8，44%）和二尖瓣峡部区域（n = 5，28%）。针对这些间隙的导管消融成功消除了15例（83%）患者的快速性心律失常。在导管消融后49个月的随访检查中，14例患者（78%）未出现快速性心律失常复发。电生理研究显示迷宫手术后复发性房性快速性心律失常患者存在传导间隙。迷宫手术的改良应包括在传导间隙经常出现的左下肺静脉口、二尖瓣峡部和冠状窦周围进行细致的消融。对于复发的病例，针对病变的导管消融可有效控制快速性心律失常。
