迷宫手术对二尖瓣病合并的慢性心房颤动电生理的影响

Electrophysiologic Observation After the Maze Procedure for Chronic Atrial Fibrillation Associated With Mitral Valve Disease

对21例二尖瓣疾患伴心房颤动（简称房颤）施行了迷宫手术和二尖辩手术的患者，采用12导联心电图、心内电生理、动态心电图、踏车运动试验方法进行检查，探讨迷宫手术对慢性房颤患者心脏围手术期和远期电生理的影响。平均随访17．9±7．9个月。结果如下：①术后3个月90％（18／20）恢复窦性心律，随访1年以上者（14例）房颤均未见复发。②术后除1例窦房结恢复时间延长外余均正常，无窦性起搏或房室给传导功能障碍。③术后都有正常的心房激动和房室同步激动顺序。④术后在各标测部位猝发刺激和程控刺激均不能诱发心房扑动和颤动，心房各部位有效不应期均显著长于高位右房有效不应期。⑤动态心电图和运动试验证明有良好的心率变时性反应和运动耐力。⑥1例术后4个半月死于急性坏死性肝炎。以上表明通过电生理检查手段证实了迷宫手术治疗房颤能达到：①消除房颤恢复窦性心律，②重建和（或）维持房室同步活动，③恢复心房传输功能。提出对二尖瓣疾患合并的慢性房颤病人在施行二尖瓣手术时应作迷宫手术。

To find out the electrophysiologic effects of the maze procedure for chronic atrial fibrillation (AF) in pe-rioperation and follow up period, 21 patients had been followed up by elect rocardiogram, electrop hys iolog ic study,dynamic electrocardiogram and exercise stress testing methods for mean follow-up 17. 9±7. 9 months after mazeprocedure concomitant with mitral valve procedure. Results:①Follow-up 3 months after operation,the maze proce-dure cured AF and restored sinus rhythm in 18 of 20 patients (90%) .Follow-up 12 months all of these cases hadrestored sinus rhythm. ②After operation,sinus node recovery time (SNRT) and atrioventricular nodal conductiontime (AVNRT) were normal in all patients excepting 1 case who had prolonged SNRT. ③Atrial activation se-quence and atrioventricular synchrony were present in all of patients. ④Programmed electrial stimulation and high-frequency burst pacing of the atria was used in effort to induce atrial flutter or AF.It was impossible to induce atri-al flutter or AF in any of the cases.The effective refractory pericxl at atrial positions was longer than that of highright atrium. ⑤Dynamic electrocardiogram and exercise testing had proved the presence of perfect sinus node re-sponse and stress action to exercise. ⑦1 case acute necrosis hepatitis died on postopertiove 4. 5 months in normalsinus rhythm. Conclusions: the results suggest that maze procedure accomplish three loals: ①the permanent abla-tion of AF,②the restoration of atrioventricular synchrony and ③the preservation of atrial transport function,andtherefore should be considered for patients with mitral valve disease and chronic atrial fibrillation undergoing mitralvalve operations.