慢性房颤伴二尖瓣病的迷宫手术24例八年随访

Patient with valvular heart disease and chronic atrial fibrillation undergoing concomitant maze procedures: an 8-year follow-up in 24 cases

目的:评价改良迷宫术同期进行瓣膜手术的电生理效果及对心脏功能的远期影响。方法:24 例慢性房颤伴有二尖瓣疾病施行改良迷宫和二尖瓣手术的患者进行12导联心电图、心内电生理、动态心电图和超声心动图检查,平均随访(92.7±11.9)个月。结果:(1)术后3个月90%恢复窦性心律,术后1年以上100%恢复窦性心律。(2)除1例Ⅰ度房室传导阻滞外,窦房结及房室结功能检查均正常。(3)除高位右房外心房各部位有效不应期均显著延长,在心房各部位猝发和程控刺激均不能诱发房扑和房颤。(4)电生理检查有正常的心房激动和房室同步顺序。(5)动态心电图显示有良好的心率变时性反应和运动耐力。(6)随访期中再住院率为4%。(7)超声心动图显示随访期左房长径较术后明显减小[(5.52±1.22) cm vs (6.77±1.36) cm, P<0.01];随访期左房容积明显小于术后[(91.97±52.64) cm3vs(155.35±88.86) cm3, P<0.001];随访期右房长径明显小于术后[(4.72±0.85) cm vs (5.77±1.18) cm,P<0.05]。(8)左心室收缩功能正常,平均EF值为(56.00±19.75)%,平均FS值为(32.86±9.53)%。结论:在改良迷宫同时进行瓣膜手术均能安全有效的消除房颤维持窦律减小心房容积,恢复正常的房室同步传导和左心功能。

Objective:To evaluate the long-term effectiveness of electrophysiologic and cardiac performance of concomitant Maze procedure in patients with chronic atrial fibrillation complicated with valvular heart disease. Methods: Twenty-four patients were followed up with electrocardiogram, dynamic electrocardiograms and electrophysiologic study for (92.7±11.9) months after Maze procedure concomitant with mitral valve procedure.Results: (1)Sinus rhythm was restored in 90% of patients after 3 months and in all after 1 year. (2)Sinus node recovery time (SNRT) and atrioventricular nodal conduction time (AVNRT) were normal in all but 1 patients who had Ⅰ degree AVB.(3) The effective refractory periods at each atrial position were longer than that of high right atrium; programmed electrical stimulation and high frequency burst pacing of the atria did not induce trial flutter or atrial fibrillation.(4) Electrophysiologic testing showed that atrial activation sequence and atrioventricular synchrony were present in all of patients.(5) Dynamic electrocardiogram proved the presence of perfect sinus node response and stress action to exercise.(6) The rehospitalization rate was 4% in follow-up period.(7) Echocardiograms showed that left atrial long diameter was significantly smaller than that of postoperation \[(5.52± 1.22) cm vs (6.77±1.36) cm, P<0.01\]; left atrial volume was significantly smaller than that of postoperation \[(91.97± 52.6) cm 3 vs (155.35±88.86) cm 3 ,P<0.001 \]; and right atrial diameter was significantly smaller than that of postoperation \[(4.72±0.85) cm vs (5.77±1.18) cm,P<0.05\].(8)Left ventricle contractile function was normal in all cases with the mean LV ejection fractions being (56.00±19.75)% and the mean LV fractional shortenings being (32.86±9.53)%.Conclusion: The results suggest that concomitance maze procedure is safe and effective in treating atrial fibrillation, maintaining sinus rhythm, preserving atrial transport function, decreasing atrial volume and improving cardiac performance.