心房細動の外科的治療における肺静脈隔離術の有効性

Efficacy of Pulmonary Vein Isolation in the Surgical Treatment of Atrial Fiburillation

心房細動（Af）は臨床上もっともよく経験する不整脈の一つであり，40歳以上の4人に1人は発症するといわれている1）．Afに対する治療は洞調律への復帰を目的としたリズムコントロールと，心拍数を調整するレートコントロールに分けられる．Afに対する外科的治療としては，1987年にCoxらがmaze手術を提唱して以降30年が経過し改変を繰り返し，maze Ⅲ手術として標準的なAf手術となったり，2003年に高周波双極デバイスが使われるようになってからはmaze Ⅳ手術が普及した2）．

Background：Maze surgery is often performed for atrial fibrillation during cardiac surgery, and a certain number of therapeutic effects are observed. However, the effectiveness of pulmonary vein isolation （PVI） remains unclear.

Methods：329 arrhythmia surgeries was performed between 2012 and 2021. The patients were divided into three groups：paroxysmal atrial fibrillation （PAf） group, persistent atrial fibrillation group （PerAf）, and long persistent atrial fibrillation （LongPerAf） group. In the PVI and maze groups, postoperative sinus rhythm rate and the rate of freedom from Af recurrence were compared.

Results：In PAf, PerAf cases, there was no difference between PVI and maze groups in the rate of freedom from recurrent Af and postoperative sinus rhythm rate.

In LongPerAf cases, the rates of freedom from recurrent Af and postoperative sinus rhythm were significantly lower in the PVI group.

Conclusion：PVI was considered effective in patients with atrial fibrillation of less than one year duration due to the simplicity of the procedure and low complications.