心房颤动的外科治疗

心房颤动(atria l fibrillation,AF)是最常见的心律失常,能引起多种并发症和死亡率的增加。AF的发病机制可能与心房内多个折返环形成有关,对药物治疗无效的难治性AF,迷宫手术通过在心房壁上的切割和缝合,阻断折返环的形成,是外科治疗AF经典、有效的方法,但操作复杂、费时,创伤大。应用冷冻、射频、微波等各种能源的消融手术,避免了切割和缝合,简化了迷宫手术方法,效果良好,但何种方法更为有效尚无定论。改进各种消融设备和技术以提高消融手术径路的连续性和透壁性,有利于进一步改善消融手术的治疗效果,提高窦性心律的永久恢复率。

Surgical Treatment of Atrial Fibrillation

Atrial fibrillation(AF) is the most common cardiac arrhythmia and associated with incremental morbidity and mortality.It is implicated that multiple reentry circuits have been the dominant mechanism of AF.The classical surgical treatment for medically refractory AF is the maze procedure composed of multiple cuts and sutures within the atrial walls to disrupt the abnormal reentry circuits.Although the maze procedure is recognized as the most effective treatment of AF,it is complicated,time-consuming and much invasive.New surgical ablation therapy,applying alternate energy sources(cryothermy,radiofrequency,microwave) have evolved to simplify the maze procedure without cut and suture and demonstrated promising success rates.The optimal lesion set has not yet been defined.Modification of lesion sets and techniques that ensure continuous and transmural lesions may improve the outcomes of ablation therapy and recover rate of sinus rhythm.