Persistent Atrial Fibrillation is Associated with Inability to Recover Atrial Contractility after MAZE IV Surgery in Rheumatic Disease

Abstract

Background: MAZE IV surgery is effective in restoring sinus rhythm (SR) and atrial contraction (AC) in patients with nonrheumatic persistent atrial fibrillation (AF). However, there is less information on its effectiveness to restore AC in patients with rheumatic disease. Aims: To assess the effectiveness of the MAZE IV surgery in restoring AC in patients with rheumatic disease and long persistent AF. Methods: Prospective, consecutive study in patients who underwent cardiovascular surgery and had long persistent AF in whom MAZE IV surgery was performed. The presence of AC was assessed by lateral mitral annulus tissue Doppler. Results: A total of 75 patients were included. Mean age 60 years (±11.7); 27 men (36%). AF duration was 63 months (±34.1). Primary indication for surgery: rheumatic mitral stenosis 67 patients and mitral insufficiency eight patients. Mean left ventricular ejection fraction (LVEF) was 51.8% (±12.1) and mean left atrial area was 37 cm2 (±10.3). After a mean follow‐up of 28 months (±9.3), 69 patients remained alive and 59 were in SR. AC was detected in 37.3% (Group A) and absent in 62.7% (Group B). The mean difference between groups was the high prevalence of AF longer than 5 years in group B (P = 0.000001). There were no differences related to left atrial size, LVEF, and age. Conclusions: In patients with rheumatic disease, the absence of correlation between SR recovery and AC recovery post MAZE IV surgery is significant. A history of long persistent AF lasting more than 5 years was a strong predictor for the absence of AC. (PACE 2012; 35:999–1004)

The Absence of Atrial Contraction as a Predictor of Permanent Pacemaker Implantation after Maze Procedure with Cryoablation

“…Moreover, approximately one-third of patients, including those with SR, failed to recover AC. These results are in good agreement with data from previous studies [3–8]. …”

“…Although some studies have evaluated AC recovery after maze operations, only serial changes in AC were described, or several risk factors for the lack of AC recovery were investigated in relatively small patient populations [3–7]. Moreover, the clinical implications of AC recovery failure during long-term follow-up have been evaluated in only a few studies.…”

“…Despite a high reported success rate of 75% to 95%, a significant proportion of patients fail to recover atrial contraction (AC) after the maze operation [3–7]. The absence of AC could compromise the efficacy of the maze procedure by limiting the atrial contribution to ventricular performance [7].…”

Outcome of Concomitant Cox Maze Procedure with Narrow Mazes and Left Atrial Volume Reduction

“…In a previous report [19], rheumatic mitral valve disease was a predictive factor of low atrial contraction recovery (absence of left atrial A waves) in patients who experienced sinus rhythm recovery after the maze procedure. There were more rheumatic valve patients than non-rheumatic valve patients in the present study, and the left atrial A waves were present less often in rheumatic valve patients; however, a rheumatic mitral lesion did not affect the presence of left atrial contraction in the stratified analysis, which was performed to evaluate the impacts of mitral valve surgical methods and rheumatic valve lesions in the presence of the left atrial A waves.…”

The Challenge of Atrial Tachycardia Management in Rheumatic Heart Disease

“…The outcomes are reasonably optimistic, with return and maintenance of sinus rhythm reported in roughly 60% of cases, and a lower risk of thromboembolic events compared to patients who did not receive a surgical Maze . However, there are lingering concerns that atrial transport function may be negatively impacted by incorporating a Maze into rheumatic mitral valve surgery, which could reduce performance of a prosthetic valve . Even more contentious is the notion of a prophylactic surgical Maze at time of mitral valve surgery in patients who are in stable sinus rhythm preoperatively, with a goal of reducing the likelihood of later atrial arrhythmias.…”