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目的探讨风湿性心脏病慢性心房颤动（房颤）心外膜标测图形特征及左侧迷宫和左房隔离术消除房颤近期及远期效果。方法１７例风湿性心脏病慢性房颤患者有明确房颤病史平均２．０±２．３年，均有二尖瓣疾患合并主动脉或三尖瓣疾患需手术治疗。根据不同术式分为：（１）左侧迷宫组５例；（２）左房隔离组９例；（３）左房冷冻或左心耳结扎组３例。采用左房右房１６导联同步心外膜标测。结果（１）心外膜标测左房异常电图分析：左房后壁中部为慢性传导区，发生率２３．５％，双峰电位发生率以左房后壁最高３９．３７％，依次为左房上部２５．６％，左房下部９％，左心耳５．６％。碎裂电位发生率以左房后壁中部最高１７．４％，依次为左房上部１０．６６％，左心耳２．５％，左房下部０．８％。（２）左侧迷宫术后心外膜标测，３例双房均示窦性心律，２例双房均示心房扑动，无房颤。随访６周以上者均为窦性心律。（３）左房隔离术后３个月窦性心律达２２％（２／９），随访半年以上窦性心律达５例（５／８），随访２年以上者窦性心律达４例（４／８）。结论本研究提示风湿性心脏病慢性房颤左房后壁中部存在缓慢传导区，单纯作左侧迷宫术近期随访和左房隔离术远期随访的成功率分别为８０％和５０％。
Objective To investigate the characteristics of epicardial mapping of chronic atrial fibrillation (AF) patients with rheumatic heart disease and the effects of left maze and left atrial septum in eliminating short-term and long-term effects of atrial fibrillation. Methods A total of 17 patients with chronic atrial fibrillation who had rheumatic heart disease had a history of atrial fibrillation (mean 2.0 ± 2.3 years). All patients had mitral valve disease complicated with aortic or tricuspid valve disease requiring surgical treatment. According to different surgical procedures are divided into: (1) left maze group in 5 cases; (2) left atrial septum group in 9 cases; (3) left atrial freezing or left atrial appendage ligation group in 3 cases. Left atrial and right atrial lead 16-lead synchronous epicardium mapping. Results (1) ECG analysis of left atrial abnormalities: epicardial posterior wall of the middle of the chronic conduction area, the incidence rate of 23.5%, bimodal potential incidence of left atrial posterior wall up to 39.37%, followed by 25.6% of the upper left atrium, 9% of the lower left atrium, and 5.6% of the left atrial appendage. Fragmentation potential in the left atrium posterior wall of the highest 17.4%, followed by the left atrium 10.66%, left atrial appendage 2.5%, left atrium 0.8%. (2) After the left maze epicardium mapping, 3 cases of double room showed sinus rhythm, 2 cases of double room showed atrial flutter, no atrial fibrillation. Follow-up more than 6 weeks were sinus rhythm. (3) The sinus rhythm was 22% (2/9) at 3 months after left atrial septum segmental operation. Sinus rhythm was observed in 5 cases (5/8) in more than half a year, followed up for more than 2 years. 4/8). Conclusions This study suggests that there is a slow conduction area in the middle of the left posterior wall of patients with rheumatic heart disease. The success rates of short-term follow-up and left atrial septal simple follow-up were 80% and 50% respectively.