McCarthy P M, Castle L W, Maloney J D, Trohman R G, Simmons T W, White R D, Klein A L, Cosgrove D M
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.
J Thorac Cardiovasc Surg. 1993 Jun;105(6):1077-87.
From January 1991 until May 1992, a total of 14 patients (mean age 48 years) underwent the maze procedure for refractory atrial fibrillation (mean duration, 7 years; mean number of antiarrhythmic medications, six). Three patients had had embolic events, one patient had had a cardiac arrest from flecainide, one had pulmonary fibrosis from amiodarone, and six of ten who were employed were temporarily disabled. Two patients underwent successful mitral valve repair in which the maze procedure was added as a secondary goal of the operation. Postoperative fluid retention was a problem in five patients (36%). Six patients (43%) were temporarily treated with an antiarrhythmic medication. Two patients (14%) with preoperative sick sinus syndrome required pacemakers. One patient was discharged from the hospital but died suddenly less than 1 month after the operation (7% operative mortality) of hyperkalemia caused by acute renal failure. All patients beyond 3 postoperative months (100% "cure") are receiving no antiarrhythmic medications, have sinus rhythm, or have p-wave tracking with ventricular pacing. Atrial contraction has been documented by cinegraphic magnetic resonance imaging studies and by Doppler echocardiography performed when sinus rhythm had resumed. The maze procedure is an extensive operation but is indicated for selected patients who have the severe sequelae of atrial fibrillation.
从1991年1月至1992年5月，共有14例患者（平均年龄48岁）接受了迷宫手术治疗难治性心房颤动（平均病程7年；平均抗心律失常药物数量为6种）。3例患者曾发生栓塞事件，1例患者因氟卡尼导致心脏骤停，1例因胺碘酮导致肺纤维化，10名就业患者中有6名暂时致残。2例患者成功进行了二尖瓣修复，其中迷宫手术作为手术的次要目标被加做。5例患者（36%）术后出现液体潴留问题。6例患者（43%）接受了抗心律失常药物的临时治疗。2例术前患有病态窦房结综合征的患者需要安装起搏器。1例患者出院，但术后不到1个月因急性肾衰竭导致高钾血症突然死亡（手术死亡率7%）。所有术后3个月以上的患者（100%“治愈”）均未服用抗心律失常药物，维持窦性心律，或在心室起搏时出现P波跟踪。通过电影磁共振成像研究以及窦性心律恢复时进行的多普勒超声心动图检查记录到了心房收缩。迷宫手术是一项广泛的手术，但适用于患有心房颤动严重后遗症的特定患者。
