Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure
Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure
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DOI：
10.1016/j.jtcvs.2007.10.063
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发表时间：
2008-04-01
影响因子：
6
通讯作者：
Damiano, Ralph J., Jr.
中科院分区：
文献类型：
--
作者：
Voeller, Rochus K.;Bailey, Marci S.;Damiano, Ralph J., Jr.
目的：Cox迷宫术中每条消融线对房颤治疗的重要性仍不明确。本研究评估了在左、右肺静脉隔离之间进行单一连接病变与隔离整个左后心房的2个连接病变（盒状病变）的手术结果的差异。方法：对2002年4月至2006年9月行Cox迷宫术的137例患者进行前瞻性资料收集。在2004年5月之前，肺静脉与单个双极射频消融病灶相连（n +/- 56），而在此之后，常规进行了盒状病变（n 5 81）。平均随访时间为11.8±69.6个月。结果：单连接病变组早期房性心动过速发生率明显高于盒状病变组（71% vs 37%, P < 0.001）。盒状病变组房颤复发的总体自由度显著高于1个月（87%对69%，P = 0.015）和3个月（96%对85%，P = 0.028）。盒状病变组抗心律失常药物的使用在3个月（35% vs 58%, P = 0.018）和6个月（15% vs 44%, P = 0.002）时显著降低。结论：通过在肺静脉之间建立一个盒子状病变而不是单个连接病变来隔离整个左后心房，可以显著降低早期心房速性心律失常的发生率，在1和3个月时房颤复发的自由度更高，在3和6个月时抗心律失常药物的使用率更低。所有接受Cox迷宫手术的患者应包括完整的盒状病变。
Objectives: The importance of each ablation line in the Cox maze procedure for treatment of atrial fibrillation remains poorly defined. This study evaluated differences in surgical outcomes of the procedure performed either with a single connecting lesion between the right and left pulmonary vein isolations versus 2 connecting lesions (the box lesion), which isolated the entire posterior left atrium.Methods: Data were collected prospectively on 137 patients who underwent the Cox maze procedure from April 2002 through September 2006. Before May 2004, the pulmonary veins were connected with a single bipolar radiofrequency ablation lesion (n +/- 56), whereas after this time, a box lesion was routinely performed (n 5 81). The mean follow-up was 11.8 +/- 69.6 months.Results: The incidence of early atrial tachyarrhythmia was significantly higher in the single connecting lesion group compared with that in the box lesion group (71% vs 37%, P < .001). The overall freedom from atrial fibrillation recurrence was significantly higher in the box lesion group at 1 (87% vs 69%, P = .015) and 3 (96% vs 85%, P = .028) months. The use of antiarrhythmic drugs was significantly lower in the box lesion group at 3 (35% vs 58%, P = .018) and 6 (15% vs 44%, P = .002) months.Conclusions: Isolating the entire posterior left atrium by creating a box lesion instead of a single connecting lesion between the pulmonary veins showed a significantly lower incidence of early atrial tachyarrhythmias, higher freedom from atrial fibrillation recurrence at 1 and 3 months, and lower use of antiarrhythmic drugs at 3 and 6 months. A complete box lesion should be included in all patients undergoing the Cox maze procedure.