Yuda S, Nakatani S, Isobe F, Kosakai Y, Miyatake K
Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
J Am Coll Cardiol. 1998 Apr;31(5):1097-102. doi: 10.1016/s0735-1097(98)00058-8.
We sought to determine the effectiveness of the maze procedure for restoring atrial contraction in patients with and without giant left atrium (GLA).
Although the maze procedure has been reported to be effective for refractory atrial fibrillation, it is unknown whether this procedure can restore effective atrial contraction in patients with GLA.
Nineteen patients with and 32 patients without GLA were studied with Doppler echocardiography before and after the maze procedure. Peak velocity and the time-velocity integral of the left ventricular diastolic filling wave during atrial contraction (A wave) and the atrial filling fraction calculated as the ratio of the time-velocity integral of the A wave to that of total diastolic filling were compared between patients with and without GLA. A peak A wave velocity > or =10 cm/s was considered to indicate echocardiographic evidence of effective atrial contraction.
Regular rhythm with P waves was restored in 10 patients (53%) with and 26 (81%, p < 0.05) without GLA. Four patients (21%) with and 21 patients (66%, p < 0.01) without GLA showed effective atrial contraction by echocardiography. Once atrial contraction was resumed, the degree of atrial contraction was comparable between patients with and without GLA (17+/-5% vs. 17+/-4% for atrial filling fraction at 12 months, respectively).
Although most patients without GLA had restored atrial contraction by the maze procedure, it was resumed in fewer patients with GLA. However, once atrial contraction was resumed, the degree of atrial contraction was comparable between patients with and without GLA. Therefore, the maze procedure may be an option in selected patients with GLA.
我们试图确定迷宫手术在恢复有或无巨大左心房(GLA)患者心房收缩方面的有效性。
尽管据报道迷宫手术对难治性心房颤动有效,但该手术能否恢复GLA患者有效的心房收缩尚不清楚。
对19例有GLA的患者和32例无GLA的患者在迷宫手术前后进行多普勒超声心动图检查。比较有和无GLA患者心房收缩期(A波)左心室舒张期充盈波的峰值速度和时间-速度积分,以及A波时间-速度积分与总舒张期充盈时间-速度积分之比计算的心房充盈分数。A波峰值速度≥10 cm/s被认为提示有效心房收缩的超声心动图证据。
10例(53%)有GLA的患者和26例(81%,p<0.05)无GLA的患者恢复了有P波的规则心律。4例(21%)有GLA的患者和21例(66%,p<0.01)无GLA的患者经超声心动图显示有有效的心房收缩。一旦恢复心房收缩,有和无GLA患者的心房收缩程度相当(12个月时心房充盈分数分别为17±5%和17±4%)。
尽管大多数无GLA的患者通过迷宫手术恢复了心房收缩,但有GLA的患者恢复的较少。然而,一旦恢复心房收缩,有和无GLA患者的心房收缩程度相当。因此,迷宫手术可能是部分有GLA患者的一种选择。