An 8 1/2-year clinical experience with surgery for atrial fibrillation
An 8 1/2-year clinical experience with surgery for atrial fibrillation
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DOI：
10.1097/00000658-199609000-00003
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发表时间：
1996-09-01
影响因子：
9
通讯作者：
Boineau, JP
中科院分区：
文献类型：
--
作者：
Cox, JL;Schuessler, RB;Boineau, JP
目的分析迷宫手术治疗房颤的前81年半的临床结果。摘要背景数据房颤的发生率为0.4%~2%，约10%的患者年龄在60岁以上。它与严重的发病率和死亡率有关。方法1987年9月25日至1996年3月1日，178例患者接受迷宫手术，心率不规则引起不适，房室同步收缩丧失影响血流动力学，血流停滞增加血栓栓塞的易感性。32例患者接受了迷宫-I手术，15例患者接受了迷宫-II手术，118例患者接受了迷宫-III手术。分析164例患者术后3个月至81年半期间心房扑动和心房颤动复发情况。分析患者的心房转运功能、窦房结功能和术后起搏器使用情况。结果93%的患者在未使用任何抗心律失常药物的情况下心律失常消失。其余心律失常复发的患者均经药物治疗转为窦性心律，AIL患者经直视、经食道超声心动图或房室对室起搏均有心房转运功能。98%的患者有右房功能，94%的患者有左房功能。107例术前窦房结正常的患者中，只有1例需要永久起搏器。结论迷宫手术是治疗难治性房颤的有效方法。
ObjectiveThe authors analyzed the clinical results during the first 81/2 years' experience with the Maze procedure for the surgical treatment of atrial fibrillation.Summary Background DataAtrial fibrillation occurs in 0.4% to 2% of the general population and in approximately 10% of patients older than 60 years of age. It is associated with significant morbidity and mortality. The irregular heartbeat causes discomfort, the loss of synchronous atrioventricular contraction compromises hemodynamics, and the stasis of blood flow increases the vulnerability to thromboembolism.MethodsFrom September 25, 1987 to March 1, 1996, 178 patients underwent the Maze procedure. Thirty-two patients underwent the Maze-I procedure, 15 underwent the Maze-II procedure, and 118 underwent the Maze-III procedure. Patients were analyzed for recurrence of atrial flutter and atrial fibrillation between 3 months and 81/2 years after surgery (n = 164). Patients were analyzed for atrial transport function, sinus nodule function, and postoperative pacemaker requirements.ResultsNinety-three percent of all patients were arrhythmia free without any antiarrhythmic medication. Of the remaining patients with arrhythmia recurrence, all were converted to sinus rhythm with medical therapy, Ail patients were documented to have atrial transport function by either direct visualization, transesophageal echocardiography, or atrioventricular versus Ventricular pacing at the same rate. Ninety-eight percent had documented right atrial function, and 94% had left atrial function. Of the 107 patients in this series who were documented to have a normal sinus node preoperatively, only 1 patient required a permanent pacemaker.ConclusionThe Maze procedure is an effective treatment for medically refractory atrial fibrillation in properly selected patients.