A brief overview of surgery for atrial fibrillation
A brief overview of surgery for atrial fibrillation
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DOI：
10.3978/j.issn.2225-319x.2014.01.05
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发表时间：
2014-01-01
影响因子：
3.1
通讯作者：
Cox, James L.
中科院分区：
文献类型：
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作者：
Cox, James L.
迷宫手术是第一种消融而非隔离房颤的手术技术，于1987年首次在临床上进行。迷宫手术所依据的实验和临床电生理标测图表明，在确定的房颤（AF）期间存在两个或更多个大（直径5-6 cm）的大折返回路。11年后，确定了主要在肺静脉内和周围的局灶性触发，并显示其负责诱发房颤的个体发作。因此，很明显，大多数患者的阵发性房颤发作可以通过隔离或消融肺静脉区域来治疗，但一旦房颤变为非阵发性，因此依赖于大折返回路来维持，仍然需要执行某种类型的附加过程来中断这些电路。在美国接受冠状动脉旁路移植术（CABG）、主动脉瓣置换术（AVR）或二尖瓣手术的约100，000名患者也患有相关AF，但其中只有20%的患者接受了消融AF的伴随手术。然而，多项研究表明，在这些其他初次手术时治疗AF可改善生活质量，减少长期中风，提高长期生存率，同时不增加整体手术风险。此外，主要的心脏病学和外科学会建议在可行的情况下在所有病例中进行伴随AF手术。接受CABG和AVR的阵发性AF患者应接受肺静脉隔离，而非阵发性AF（持续性或长期持续性AF）患者应接受迷宫手术。患有阵发性房颤或非阵发性房颤的二尖瓣手术患者应接受迷宫手术。
The Maze procedure was the first surgical technique developed to ablate, rather than isolate, atrial fibrillation and was first performed clinically in 1987. The experimental and clinical electrophysiological maps on which the Maze procedure was based demonstrated the presence of two or more large (5-6 cm diameter) macro-reentrant circuits during established atrial fibrillation (AF). Eleven years later, focal triggers were identified, primarily in and around the pulmonary veins, and were shown to be responsible for the induction of individual episodes of AF. Thus, it became clear that episodes of paroxysmal AF could be treated in most patients by isolating or ablating the region of the pulmonary veins, but that once AF became non-paroxysmal and thus dependent upon the macro-reentrant circuits for its maintenance, it would still be necessary to perform some type of additional procedure to interrupt those circuits. Approximately 100,000 patients who undergo coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or mitral valve surgery in the US also have associated AF, but only 20% of them undergo a concomitant procedure to ablate the AF. However, multiple studies have demonstrated that treating the AF at the time of these other primary operations results in an improved quality of life, fewer long-term strokes and improved long-term survival while adding no risk to the overall surgical procedure. Moreover, the major cardiology and surgery societies recommend that concomitant AF surgery be performed in all cases when feasible. Patients undergoing CABG and AVR who have paroxysmal AF should undergo pulmonary vein isolation, while those with non-paroxysmal AF (persistent or long-standing persistent AF) should have a Maze procedure. Patients undergoing mitral valve surgery who have either paroxysmal AF or non-paroxysmal AF should undergo a Maze procedure.