Treatment Of Atrial Fibrillation With Modified Maze Procedure With Refrigeration And Incised Suture

Since 1984, Allessie has suggested that the pathophysiological basis of atrial fibrillation was the hypothesis of multiple reciprocal circling, and Maze procedure was devised and evoluted from the hypothesis. Cox did a lot of animal experiments to find that all animal model and clinical atrial flutter and atrial fibrillation played background on macro reentry circle. In the Procedure of atrial flutter and atrial fibrillation, never found mini-reentry circle or Cardio-automatic component. So we can give surgical treatment to therapy atrial flutter and atrial fibrillation, the purpose of surgery is to amputate reentry circle to terminate clinical atrial flutter and atrial fibrillation. In addition, the design of operation should make the impulse of atrionector; sino-atrial node pass through a definited pathway to atrioventricular node, at the same time, the impulse should follow single direction to left and right atrium in order to recovery atrioventricular synchronism and atrial contraction function. In the operation, atrio- nicking divided left and right atrium into the shape of labyrinth, so we named the operation as Maze procedure. But the operation is complicated and danger: the procedure was long; myocardial preservation was poor; coronal vessel was easy to be hurted; At earlier postoperative period, aconduction block was easy to cause and more bleeding; Atrionector did poor response for heartnormal rate and functional disorder of left auricle, and so on. Therefore, Cox modified the operation and had satisfactory result. Simultaneously, the domestic and abroad scholars modified the operation according to Cox's principle of classicslabyrinth, too. For example: Freezing, Alcohol cauterization, electric coagulation and radio-frequency ablation. Through these methods, they hoped to simplified operative procedure, Shorten operation time, and decrease postoperative complications.In our investigation, we substituented nicking of left auricle by freezing. At present, freezing substituenting for partor all auricle nicking is the most extensive method of modified opration. It was reported by Gaita that the freezing region of biopsy atrio-constitution manifested cardiac muscle nucleus and cell plasma had degenerated, and these changes is un-reversible injuries; there are not survival cardiac muscle cell and injuries transfixed entire cardia-wall. Because freezing lead tomyocardial cell necrosis, but never affect on collagen fibers, in the injured region, compact fibrous tissue formatied scar and avoid disruption and dilataltion. Moreover, freezing can keep integrity of endocardium, which decrease the danger ofthrombosis and embolism. We divide auricula into three areas: operation hazardous area; atrial fibrillation original area; atrial fibrillation extension area. (1) operation hazardous area: including the area of atrionector, atrioventricular node, blood vessel supported atrionector,atrioventricular node and bundles of atrial septum. These areas should avoid operating. (2) atrial fibrillation original area: The opening of pulmonary vein at the basal part of left atrium, we are freezing these areas. (3) atrial fibrillation extension area: besides atrial fibrillation extension area, atrial septum and right atrium, we advocate that auricle constitution should not be amputated comprehensively. The opening of pulmonary vein at the basal partof left atrium should be operated expandingly to preclude the source of atrial fibrillation and avoid injury auricle excessively. Adopting our method need not break superior vena cava, prevent severe auricle nicking bleeding and simplify operative procedure. We also maintain that atrio-constitution should not freeze extensively to avoid producing more myocardium freezing zone to loss their function, which violate our purpose. After maze procedure, auricula usually manifests non-mechanical Activity named atrio-quiescenceatrio-paralysis is 31%. But in our investigation, the incidence is zero. In atrial fibrillation original area, we freeze left atrium posterior wall around orifices of left superior pulmonary vein, left inferior pulmonary vein, right superior pulmonary vein, right inferior pulmonary vein, respectivly. In classics maze procedure and other modified maze procedure, these area of four pulmonary vein was wholly separated so that above 50% myocardium contraction of left atrium function is lost ,which lead to left atrium paralysis. Comparedwith classics maze procedure, three month ago, in the classics maze procedure team is 60%, and in the classics maze procedure team, 38% patients occur atrionector dysfunction and demond installing permanent lead introduce. In our operation team, the maintenance rate of sinus-heart rate is 90%, no one occur atrionector dysfunction and demond installing permanent lead introduce. In observing team, the time of precluding atrial fibrillation is 22-31 min, average 24min; In contrasting team, the time of precluding atrial fibrillation is 50-102min,average 69 min; In contrasting team, the incidence of atrio-nicking haemorrhagia is 8%-28%; In observing team, only one patient occur pericardium plugging, but the reason of pericardium plugging is not atrio-nicking haemorrhagia but is right pleura disruption; In observing team, the quantity of drainage from pericardium mediastina in 48 hour after operation is 450-1000ml, average 573 ml; In contrasting team, the quantity of drainage from pericardium mediastina is 300-700ml, average 519ml; using statistics calculation, P > 0.05. there are not significant difference, which manifest in our modified operation the quantity of drainage from pericardium mediastina is not increase notably.The result of our investigation manifest: the method that we adopt the modified Maze procedure of part atrium nicking substitutied by freezing therapy atrial fibrillation is simple and convenient; the nicking of heart is decreased; the time of operation is...