Partial Maze Procedure Is Effective Treatment for Chronic Atrial Fibrillation Associated with Valve Disease

Abstract

The maze procedure may be performed in combination with valve operations to treat chronic atrial fibrillation associated with valve dysfunction. Although we initially used the modified Cox maze III procedure, a more limited partial maze procedure is now preferred because the left atrium might be considered as the electrical impetues for atrial fibrillation. In this study we compared the results of 30 patients (group I) who underwent the full biatrial modified Cox maze III and 20 (group II) patients the partial maze procedure. While the rates of restored sinus rhythm were the same in both groups at 6‐month follow‐up (I: 83.3%, vs II: 80%), the following advantages were noted in the patients undergoing the partial maze procedure: shorter operative times, lesser elevations of creatine phosphokinase, lower rate of blood transfusion, lower rate of junc‐tional rhythm soon after the operation, and a higher P wave in those patients with restored sinus rhythm. The effectiveness of the partial maze procedure seems equal to that of the biatrial modified Cox maze III procedure for atrial fibrillation associated with valve disease. The partial maze procedure is simple and less invasive, and thus might be applied more frequently as an additional procedure to valve operations without additional risk.

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

“…3,4,21,22,24,25,27,31,32,37 The remaining 15 studies (53.6%) were retrospective observational, of which 3 were propensity adjusted. 5,19,20,26,[28][29][30]33,34,38,39,[44][45][46][47] In 16 studies (57.1%) all the patients enrolled presented exclusively non-paroxysmal AF forms and these studies constituted the "non-paroxysmal AF subgroup." [20][21][22][23][25][26][27][28][34][35][36][37][38][39]46,47 clearly specify the types of AF included.…”

“…28,31,32,46 CM3 or CM3 plus RF ablation or cryoablation were used in four studies. 3,4,27,38 Criteria to decide between BA and LA approach were randomization in three RCT, 23,35,36 clinical characteristics (ie, AF duration, LA size) in two studies, 24,32 BA approach when the RA was already open for a right-sided procedure (ie, tricuspid repair) in two studies, 33,37 serial timeframes (from 1994 to 1997 BA and subsequently LA approach) in one study, 38 Instead, for non-randomized studies, the Newcastle-Ottawa Scale score ranged between 5 and 7 for any of the included studies (mean 6.1 ± 0.5): as shown in Supplementary Material S2, none of the studies took a point either for question S3 and S4 since none of these studies had a control group with healthy voluntary patients, limiting the maximum achievable score for any of the included study to 7.…”

“…,21,23,[25][26][27][28]32,36,46 while in the remaining studies various types of main procedures (coronary surgery, valve surgery, aortic surgery, etc) were performed aside of AF ablation. Four studies23,28,36,47 enrolled only patients rheumatic valve disease (RVD) in both study groups, while 4 more studies21,27,32,37 reported a variable quota of RVD ranging between 50% and 70% of the population, while in the remaining 20 studies the incidence of RVD was not clearly stated.In 25 studies (89.3%) the same type of ablation energies were used in both BA and LA groups 5,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][44][45][46][47]. A CM4 procedure, using different types of energies, was performed in all except five studies: of these five,Takami38 and Takasaki 27 performed a CM3 procedure ("cut and sew" technique) with some of the lesions achieved using cryoablation.…”

Biatrial versus Isolated Left Atrial Ablation in Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…In all, 21 studies were included in this meta-analysis, including three prospective randomized trials [ 23 – 25 ], five prospective observational studies [ 13 , 26 – 29 ], and 13 retrospective observational studies [ 8 , 12 , 14 , 15 , 21 , 22 , 30 – 36 ]. The risk of bias in each study is shown in Figure 2 and Table 1 .…”

Comparative efficacy of biatrial and left atrial surgical ablation for atrial fibrillation

“…На данный момент сравнительная эффективность биатриальной (БА) и левопредсердной (ЛП) схем фрагментации остается сложным предметом дискуссии для современных клиницистов и хирургов. В современных исследованиях, включая 2 рандомизированных [7,8] и 4 ретроспективных обсервационных исследования [9][10][11][12], показана сопоставимая эффективность как левопредсердной (ЛП), так и биатриальной (БА) абляции [11,13]. В то же время другие исследования [14][15][16], включая 2 метаанализа, показывают, что БА абляция способствует более длительной свободе от возврата ФП.…”