Long-term results of radiofrequency maze procedure for persistent atrial fibrillation with concomitant mitral surgery

Abstract

Background: The radiofrequency (RF) maze procedure can effectively restore sinus rhythm in most patients with persistent atrial fibrillation (AF) and mitral disease. However, long-term results and predictors for late AF recurrence are still under investigation.Methods: From December 1995 to November 2011, 207 consecutive patients with persistent AF and mitral disease underwent RF maze procedure and concomitant mitral surgery. The mean age was 54±12.4 year-old.Mitral surgery was performed in all patients and concomitant procedures including tricuspid surgery, aortic valve surgery, and atrial septal defect closure were carried on 164 patients.Results: The in-hospital mortality was 3.9% (n=8) and late mortality was 8.2% (n=17). After a mean follow-up period of 101±50.9 months, 154 patients (74.4%) had long-term sinus conversion. A permanent pacer was implanted in 8 patients (3.9%). By Cox multivariate survival regression analysis, predictors for long-term sinus conversion were identified to be the duration of persistent AF, preoperative left atrial (LA) diameter, preoperative right atrial (RA) area, and preoperative beta-blocker use. The receiver operating characteristic (ROC) curve analysis showed that the best cutoff value for persistent AF duration, preoperative LA diameter, and preoperative RA area were 59.5 months, 59.85 mm, and 25.65 cm 2 . Conclusions: Longer persistent AF duration, larger preoperative LA diameter, larger preoperative RA area and preoperative beta-blocker use were the predictors for negative long-term outcome of RF maze procedure for the patients with persistent AF underwent concomitant mitral surgery. Timely referral of patients for surgery is mandatory.

Clinical Study on Long-Term Sinus Reversion Rate and Left Atrial Function Recovery of Mitral Valve Disease with Atrial Fibrillation under Modified Surgical Radiofrequency Ablation

“…In addition to structural measurement, mechanical ejection function, hemodynamics, and other indicators have been added to the detection of left atrial function [5][6][7]. Many studies have investigated the recovery of left atrial function in patients with paroxysmal atrial fibrillation after interventional ablation [8][9][10][11], but there are few reports on the recovery of left atrial function after surgical treatment of valvular disease combined with atrial fibrillation [12][13][14]. In this study, patients with valvular disease complicated by atrial fibrillation were selected as the study subjects.…”

Efficacy of the Stand-Alone Cox-Maze IV Procedure in Patients with Longstanding Persistent Atrial Fibrillation

“…[12] This has led to the development of the Cox-Maze IV procedure (CMP-IV). [13,14] The CMP-IV has excellent efficacy as shown by our group and others [15][16][17], with 77% freedom from ATAs at 10 years [18]. The late survival benefit associated with concomitant CMP-IV has also been well-established.…”

Predictor of atrial fibrillation recurrence in patients who underwent a tricuspid valve operation with modified Cox maze procedure

“…These new risk prediction models use LA diameter as a scoring factor. LA diameter, LAVI, and LA strain [11][12][13][14] are well known for AF recurrence prediction in both lone AF and AF in SHD. This is also in line with the fact that pulmonary vein isolation is the most recommend strategy in AF 15,16 .…”

“…This is also in line with the fact that pulmonary vein isolation is the most recommend strategy in AF 15,16 . Beside LAVI, RA area 13 , AF duration 13,17 and size of F wave 17 are known for predicting AF recurrence. In this study, suppression of AF recurrence after the CM procedure with TV surgery was up to baseline RAD and age.…”