Factors affecting rhythm after the maze procedure for atrial fibrillation.
Factors affecting rhythm after the maze procedure for atrial fibrillation.
复制标题
心房颤动迷宫手术后影响心律的因素。
作者：
Akira Kawaguchi;Yoshio Kosakai;Fumitaka Isobe;Y. Sasako;K. Eishi;Kiyoharu Nakano;N. Takahashi;Y. Kawashima
背景
迷宫手术在14%有器质性心脏损害的患者中未能消除心房颤动(AF)。确定致病风险因素将通过治疗这些因素或避免高危患者来改善结果。
方法和结果
我们分析了192例房颤患者，这些患者同时接受了三种不同的迷宫手术：瓣膜病变矫正术(165例)、先天性畸形矫正术(19例)、孤立性房颤(7例)和缺血性心脏病矫正术(1例)。对165例消融成功的房颤患者和27例迷宫术后房颤患者的术前26个因素和2个术后心脏大小参数进行多因素分析。在所有因素中，术后左房内径是诱发持续性房颤的最大因素。房颤持续时间、左房内径和心胸比率被确定为术前危险因素，而迷宫操作和基础疾病的发病机制和位置的改变未能对术后心律产生显著的预后影响。术前三个变量的个体风险分析显示，缩小左房内径以使其内径正常化在迷宫手术后决定节律中起着关键作用。
结论
结果有利于在这些危险因素出现之前尽早进行手术，在此之后放弃手术或扩大左房折叠术可能是合适的。这需要进一步研究。
BACKGROUND
The maze procedure failed to abolish atrial fibrillation (AF) in 14% of patients with underlying organic cardiac lesions. Identification of contributing risk factors will improve results either by treatment of such factors or by avoidance of high-risk patients.
METHODS AND RESULTS
We analyzed 192 consecutive patients with AF undergoing three variations of the maze procedure performed simultaneously with correction of valvular diseases (n = 165), congenital anomalies (n = 19), isolated AF (n = 7), and ischemic disease (n = 1). Twenty-six preoperative factors and two postoperative cardiac size parameters were analyzed by multivariate analyses between patients with successfully ablated AF (n = 165) and those who remained in AF (n = 27) after the maze procedure. Among all factors, postoperative left atrial dimension was the most potent in predisposing patients to persistent AF. Duration of AF left atrial dimension, and cardiothoracic ratio were identified as preoperative risk factors, whereas modifications of the maze procedure and pathogenesis and location of underlying disease failed to have a significant prognostic impact on rhythm after surgery. Individual risk analysis using the three preoperative variables revealed that left atrial size reduction to normalize its dimension played a pivotal role in determining rhythm after the maze procedure.
CONCLUSIONS
Results favor earlier performance of the procedure before these risk factors develop, after which omission of the procedure or extensive left atrial plication may be appropriate. This requires further study.