风湿性心脏病慢性心房颤动左侧迷宫术的电生理观察

目的探讨风湿性心脏病慢性心房颤动（房颤）心外膜标测图形特征及左侧迷宫和左房隔离术消除房颤近期及远期效果。方法１７例风湿性心脏病慢性房颤患者有明确房颤病史平均２．０±２．３年，均有二尖瓣疾患合并主动脉或三尖瓣疾患需手术治疗。根据不同术式分为：（１）左侧迷宫组５例；（２）左房隔离组９例；（３）左房冷冻或左心耳结扎组３例。采用左房右房１６导联同步心外膜标测。结果（１）心外膜标测左房异常电图分析：左房后壁中部为慢性传导区，发生率２３．５％，双峰电位发生率以左房后壁最高３９．３７％，依次为左房上部２５．６％，左房下部９％，左心耳５．６％。碎裂电位发生率以左房后壁中部最高１７．４％，依次为左房上部１０．６６％，左心耳２．５％，左房下部０．８％。（２）左侧迷宫术后心外膜标测，３例双房均示窦性心律，２例双房均示心房扑动，无房颤。随访６周以上者均为窦性心律。（３）左房隔离术后３个月窦性心律达２２％（２／９），随访半年以上窦性心律达５例（５／８），随访２年以上者窦性心律达４例（４／８）。结论本研究提示风湿性心脏病慢性房颤左房后壁中部存在缓慢传导区，单纯作左侧迷宫术近期随访和左房隔离术远期随访的成功率分别为８０％和５０％。

Electrophysiologic observation of leftsided maze procedure for chronic atrial fibrillation associated with rheumatic heart disease

Objective The aim of this study was to investigate the characteristics of epicardial mapping findings and the effects of surgical treatment in eliminating chronic atrial fibrillation(AF) associated with rheumatic valvular disease. Methods Surgical procedures for eliminating chronic AF(mean duration 2.02.3 years) were performed concomitantly with necessitating mitral valve operations in 17 patients with rheumatic valvular disease.According to the forms of procedures,they were divided into three groups.Group(1) Leftsided maze procedure was performed in 5 cases.Group(2) Left atrial isolation procedure was performed in 9 cases.Group(3) Left atrial cryolesion application or left atrial ligation was performed in 3 cases.Electrophysiologic mapping was performed on both atrial epicardium with 16channel simultaneous recorder. Results (1)Epicardial mapping electrograms showed that slow conduction occurred at the middle posterior left atrial wall in 23.5% of them.Double potentials occurred at the posterior left atrial wall in 3937%,at the upper left atrial wall in 256%,at the lower left atrial wall in 9%,at the left atrial appendage in 56% of them.Fragmented potentials occurred at the middle of posterior left atrial wall in 17.4%,at the upper left atrial wall in 10.66%,at the left appendage in 2.5%,and at the lower portion of the left atrial wall in 0.8% of them.(2)Soon after leftsided maze procedure(5 cases),3 cases reverted to sinus rhythm in both atria,2 cases became atrial flutter.4 cases remained in sinus rhythm at the end of 6 week followup period.(3)Up to 3 months after left atrial isolation procedure(9 cases),2/9(22%)remained in sinus rhythm,5/8 displayed sinus rhythm after 6 month followup and 4/8(50%) of them kept sinus rhythm at the end of 2 year followup. ConclusionBZA slow conduction area could be observed not infreqently in the posterior wall of the left atrium in AF associated with rheumatic valvular disease.A shortterm successful rate of 80% for eliminating chronic AF was achieved by left atrial maze procedure,and a longterm successful rate of 50% was achieved by left atrial isolation procedure.