孤立性発作性心房細動患者のQuality of Lifeの改善に対しMaze手術が著効した1例

A Surgical Case Report for Lone Paroxysmal Atrial Fibrillation with Maze Procedure

　心房細動は必ずしも生命予後に関わる病態ではないが，罹患率が高く，愁訴が強く，薬物抵抗性であることが多いため，日常診療の中でも困窮することが多い疾患である．1991年にCoxが心房細動に対する根治手術（Maze手術）を発表して以来，国内においてもいくつかの施設で，手術適応のある心疾患を持つ心房細動症例に対し，Maze手術が同時に施行されている．今回われわれは，基礎心疾患のない薬物抵抗性発作性心房細動を有する患者に対しMaze手術を施行し，5年ぶりに入浴が可能になるなどQuality of lifeの著しい改善を得た症例を経験したのでこれを報告する．またインフォームド・コンセントの確立，手術の適応について考察を行い，Maze手術について，救命手術ではないが施行する価値のある手技であると考え，社会的適応の概念を提起した．

A case treated surgically for lone atrial fibrillation (AF) was reported. The patient was suffering from paroxysmal atrial fibrillation (PAP) which was resis-tant to medical treatment and had had trouble with daily living for five years. The Maze procedure was chosen as a treatment to cure this troublesome arrhyth-mia. After the operation, the patient retrieved a good quality of life.

PAP is one of the common arrhythmias which causes patients great disconfort in daily life. Since Cox demon-strated the Maze procedure in 1991, this procedure has been used as an additional surgical treatment for com-plicated AF in Japan. However, the indication of the Maze procedure has not yet been established since it is not a life-saving operation and its longterm prognosis is unknown. In this case, we undertook the Maze proce-dure for AF informed consent after repetitive thorough discussion with the patient. The main reason for using open heart surgery was the patients strong desire to be rid of the discomfort due to PAF.

This report suggested that the Maze procedure is a choice for the treatment of lone AF and we propose that it should be discussed whether or not this disorder is an indication for the use of the Maze procedure.