心房颤动外科射频消融术的演进、疗效与 术后复发：机制、预测与管理策略

Evolution, Efficacy, and Postoperative Recurrence of Surgical Radiofrequency Ablation for Atrial Fibrillation: Mechanisms, Prediction, and Management Strategies

摘要: 心房颤动(房颤)是最常见的持续性心律失常，其发病率随年龄增长显著上升，并与卒中、心力衰竭及全因死亡风险增加密切相关。以Cox-Maze系列术式为代表的外科射频消融术是治疗房颤，尤其是合并其他心脏手术指征患者的重要方法。从经典的“切割–缝合”迷宫术到以射频能量为基础的改良术式，该技术不断演进，在提高安全性与操作便捷性的同时，维持了较高的窦性心律转复率。然而，术后房颤复发仍是影响其长期疗效的核心挑战，其发生率在不同研究中存在差异，且复发机制复杂多元。本综述旨在系统梳理外科射频消融术的发展脉络，评估其临床疗效与安全性，并深入探讨术后复发的流行病学特征、潜在预测因子、病理生理学机制以及当前及新兴的预防与管理策略，以期为优化房颤外科治疗决策、改善患者长期预后提供循证依据。

Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with its incidence rising markedly with advancing age and closely linked to increased risks of stroke, heart failure, and all-cause mortality. Surgical radiofrequency ablation, represented by the Cox-Maze series of procedures, constitutes an important therapeutic approach for AF, particularly in patients with concomitant indications for cardiac surgery. From the classic “cut-and-sew” Maze procedure to modified techniques based on radiofrequency energy, this technology has continuously evolved, enhancing safety and procedural ease while maintaining a high rate of sinus rhythm restoration. However, postoperative AF recurrence remains a central challenge affecting long-term efficacy, with reported incidence varying across studies and underlying mechanisms that are complex and multifactorial. This review aims to systematically delineate the developmental trajectory of surgical radiofrequency ablation, appraise its clinical efficacy and safety, and thoroughly explore the epidemiological features, potential predictors, pathophysiological mechanisms, and current and emerging prevention and management strategies for postoperative recurrence, thereby providing an evidence-based foundation for optimizing surgical decision-making in AF and improving long-term patient outcomes.