Kawai Shunsuke, Sakamoto Kazuo, Tanaka Atsushi, Inoue Shujiro, Nagaoka Kazuhiro, Matsuura Hirohide, Takase Susumu, Nozoe Masatsugu, Abe Kohtaro, Mukai Yasushi
Department of Cardiovascular Medicine, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.
Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
J Cardiovasc Electrophysiol. 2025 Aug;36(8):1886-1894. doi: 10.1111/jce.16752. Epub 2025 Jun 4.
Catheter ablation of recurrent atrial tachyarrhythmia after Maze operation is challenging due to complex arrhythmia circuits. The aim of this study was to clarify the characteristics and ablation outcomes of atrial tachyarrhythmias after Maze operation.
Twenty-eight cases who underwent catheter ablation of post-Maze procedure atrial tachyarrhythmia (42 sessions; 1.5 per patient) in our five teaching affiliate hospitals were retrospectively analyzed. Cox-Ⅳ Maze procedure and left atrial Maze were performed in 19 cases and five cases, respectively. The mean interval between the surgery and index ablation was 62.4 months. In total, 46 atrial tachyarrhythmias were studied. Reentrant atrial tachycardia (AT) was the most common form (n = 36), whereas four atrial fibrillation (AF) and two focal AT were also observed. Identified tachyarrhythmia circuits were as follows; 16 peri-mitral, nine left atrial localized reentry (four septal, three posterior, one left atrial appendage, one anterior), six right atrial lateral incision-related, five cavo-tricuspid isthmus dependent, three roof dependent, two right atrial localized reentry (one coronary sinus, one cavo-tricuspid isthmus), one bi-atrial reentry, one pulmonary vein-left atrial reentrant tachycardia, two focal AT (one para-hisian, one coronary sinus), and one atrio-ventricular nodal reentry. Termination of targeted tachyarrhythmia was achieved in 34 sessions (81%). AT/AF recurrence free rate at 12, 24, 36 months of follow-up were 91.8%, 81.6%, and 65.3%, respectively. Seven cases underwent multiple sessions (two 2nd sessions, three 3rd sessions, and two 4th sessions). In these cases, de-novo atrial tachyarrhythmias were detected in the repeat procedures.
Most of the atrial tachyarrhythmias after Maze operation were incision/gap-related reentrant ATs, among which peri-mitral AT and LA localized reentry were the most prevalent. Although these challenging tachyarrhythmias can be treated with the contemporary mapping techniques, de-novo tachyarrhythmias can emerge in a remote period.
迷宫手术后复发性房性快速心律失常的导管消融因心律失常环路复杂而具有挑战性。本研究的目的是阐明迷宫手术后房性快速心律失常的特征和消融结果。
回顾性分析了在我们五家教学附属医院接受迷宫手术后房性快速心律失常导管消融的28例患者（42次手术；每位患者1.5次）。分别有19例和5例患者进行了Cox-Ⅳ迷宫手术和左心房迷宫手术。手术与首次消融之间的平均间隔时间为62.4个月。共研究了46例房性快速心律失常。折返性房性心动过速（AT）是最常见的形式（n = 3），同时还观察到4例心房颤动（AF）和2例局灶性AT。确定的心律失常环路如下：16例二尖瓣周围，9例左心房局限性折返（4例间隔部、3例后部、1例左心耳、1例前部），6例与右心房外侧切口相关，5例腔静脉-三尖瓣峡部依赖性，3例顶部依赖性，2例右心房局限性折返（1例冠状窦、1例腔静脉-三尖瓣峡部），1例双房折返，1例肺静脉-左心房折返性心动过速，2例局灶性AT（1例希氏束旁、1例冠状窦），以及1例房室结折返。34次手术（81%）实现了目标快速心律失常的终止。随访12、24、36个月时，AT/AF无复发率分别为91.8%、81.6%和65.3%。7例患者接受了多次手术（2例第二次手术、3例第三次手术和2例第四次手术）。在这些病例中，重复手术时检测到了新发的房性快速心律失常。
迷宫手术后的大多数房性快速心律失常是与切口/间隙相关的折返性AT，其中二尖瓣周围AT和左心房局限性折返最为常见。尽管这些具有挑战性的快速心律失常可以用当代标测技术治疗，但新发的快速心律失常可能在远期出现。
