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The Japanese Journal of Thoracic Surgery Volume 77, Issue 1 （January 2024）

胸部外科 77巻1号（2024年1月発行）

Japanese English

特集心房細動に対する外科治療2024

心房細動に対する外科的介入の早期成績と適切な術式選択 Early Outcomes and Indications for Surgical Intervention of Preoperative Atrial Fibrillation 伊佐秀貴 ¹ , 宮谷和樹 ¹ , 望月伸浩 ¹ , 鈴木文隆 ¹ , 瀬戸川友紀 ¹ , 広藤愛菜 ¹ , 國岡信吾 ¹ , 筒井真博 ¹ , 石川成津矢 ¹ , 紙谷寛之 ¹ Hideki Isa ¹ , Kazuki Miyatani ¹ , Nobuhiro Mochizuki ¹ , Fumitaka Suzuki ¹ , Yuki Setogawa ¹ , Aina Hirofuji ¹ , Shingo Kunioka ¹ , Masahiro Tsutsui ¹ , Natsuya Ishikawa ¹ , Hiroyuki Kamiya ¹ ¹旭川医科大学心臓大血管外科 ¹Department of Cardiac Surgery, Asahikawa Medical University キーワード：心房細動 , maze手術 , 肺静脈隔離術 Keyword: atrial fibrillation , maze procedure , pulmonary vein isolation pp.4-8

発行日 2024年1月1日 Published Date 2024/1/1

DOI https://doi.org/10.15106/j_kyobu77_4

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参考文献 Reference

心房細動（Af）はもっとも一般的な不整脈であり，塞栓症や心機能低下を引き起こす．Afに対する外科的アブレーションは，デバイスの新規開発や術式の簡易化によって広く普及したが，その適応やアブレーション範囲については統一した見解が得られていない．本研究では，当科におけるAfに対する外科的アブレーションの成績について検討した．

Background：This study investigates short-term outcomes following surgical interventions for atrial fibrillation （Af）, including the Cox-maze Ⅳ procedure （maze procedure） and pulmonary vein isolation （PVI）, performed concurrently with other cardiac surgeries. Additionally, we aim to determine the indications for surgical intervention for Af.

Method：We retrospectively studied a total of 1,580 patients, out of which 274 had preoperative Af, that underwent cardiac surgery between January 2015 and April 2023. Patients who underwent emergency surgery, died in the hospital postoperatively, or received pacemaker implantation were excluded. Patients were first divided into two groups：the intervention group （n＝135, 53.6％） and the non-intervention group （n＝117, 46.4％）, further categorized by whether they were in sinus rhythm at discharge. The intervention group was then subdivided into the maze procedure group （n＝54）, and the PVI group （n＝76）.

Results：Within the maze procedure group, significant differences were observed between the sinus rhythm and non-sinus rhythm groups in terms of age, preoperative Af duration, and aortic valve intervention status. In the PVI group, patients with persistent Af, longer preoperative Af duration, and larger left atrium diameter （LAD） were less likely to return to sinus rhythm. Smaller LAD was also a significant factor for returning to sinus rhythm in the non-intervention group. Multivariate analysis for all patients revealed that an LAD smaller than 50 mm was the strongest predictor for returning to sinus rhythm post operation （p＜0.01）.

Conclusion：For patients with persistent Af, the maze procedure is favored over PVI as a surgical intervention. When LAD exceeds 50 mm, the likelihood of returning to sinus rhythm is diminished.