Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation

Jessurun, Emile R.; Hemel, Norbert M. van; Defauw, Jo J.A.M.; Stofmeel, Monique A.M.; Kelder, Johannes C.; Rivière, Aart Brutel de la; Ernst, J. M. P. G.

doi:10.1161/01.cir.101.13.1559

Cited by 77 publications

(42 citation statements)

References 30 publications

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“…In fact, even if the mortality-and-stroke-rate benefit of maze over non-maze has not yet been proved, 25,26 it is reasonable to assume that the restoration of sinus rhythm improves the quality of life and perhaps survival prospects. 15,27 In our judgment, such a gain could be related to the progressive improvement of heart-chamber size and contractile performance. Indeed, our subgroup of 84 mitral patients showed a significant midterm persistence of left atrial area and of indexed LV end-diastolic volume improvement, an entity superior to that previously reported even in cases of optimal mitral valve repair.…”

Section: Lvef 12 Months After Maze (%)mentioning

confidence: 82%

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Loardi

Alamanni

Veglia

et al. 2015

Texas Heart Institute Journal

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The radiofrequency maze procedure achieves sinus rhythm in 45%-95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze-performed concomitant to elective cardiac surgery-to determine sinus-rhythm predictive factors, and describes the evolution of patients ' echocardiographic variables. From 2003' echocardiographic variables. From through 2011 A trial fibrillation (AF), the most common cardiac arrhythmia, increases morbidity and mortality rates in adults after cardiac surgery, 1 reaching a peak incidence in mitral-valve patients of 60% to 80%.2 According to several different clinical trials, 3-6 maze surgery by the cut-and-sew technique-or by alternative means of electrical blockage through the creation of linear lesions-results in sinus rhythm in 44% to 95% of patients. Its advantages consist of better survival rate and quality of life. 7,8 Although the maze procedure and its modifications have been performed since 1987, some issues remain unsolved. For example, it is uncertain how to identify features that can help in detecting patients who can truly benefit from this procedure as an adjunct to elective cardiac surgery. Moreover, whether its clinical gain is secondary, at least in part, to a favorable evolution of the dimensions and function of the cardiac chambers is still to be determined.This report of midterm follow-up of the radiofrequency maze procedure performed concomitant to elective cardiac surgery focuses upon the negative predictive role on arrhythmia recurrence played by the presence of AF at hospital discharge and, more unexpectedly, upon the positive effect of monopolar device use. It also describes the progression of patients' echocardiographic values. Patients and MethodsWe retrospectively analyzed 247 consecutive patients with structural heart disease and atrial fibrillation who were scheduled for cardiac surgery and a concomitant modi-

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Section: Lvef 12 Months After Maze (%)mentioning

confidence: 82%

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Loardi

Alamanni

Veglia

et al. 2015

Texas Heart Institute Journal

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“…According to the literature, the sinus rhythm in patients with paroxysmal AF can be observed after ablation in more than 90-95% of cases during out-patient clinical examinations 17 . Sinus rhythm is usually restored in 60-80% of patients with originally permanent AF [18][19][20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Kolek¹,

Brát²

2010

BIOMED PAP

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Aim. The aim of this prospective study was to assess the presence of sinus rhythm and atrial transport function after surgical ablation of atrial fibrillation using cryoenergy, and to evaluate predictors of the success of the procedure.Methods. Between January 2005 and September 2006, 100 consecutive patients underwent left atrial cryoablation as a concomitant surgical procedure (46 patients with paroxysmal or persistent atrial fibrillation and 54 with permanent atrial fibrillation). Mitral valve surgery was performed in 74%. The mean and the median times of follow-up were 20 ± 8.5, and 24 months respectively. Atrial mechanical function was assessed by echocardiography.Results. Sinus rhythm was achieved during the postoperative follow-up in 71-81% of patients -significantly more often in the group with paroxysmal and persistent atrial fibrillation (90-98%), than patients with permanent atrial fibrillation prior to surgery (51-65%) (p<0.002). At 12 and 24 months after the surgery, a total of 68.2% and 51.2% of the patients were free from atrial fibrillation; 73.9% and 60.7% of the patients from the paroxysmal and persistent atrial fibrillation group, and 60.3% and 37.7% of patients with permanent atrial fibrillation (p=0.05). Five per cent of patients required postoperative permanent pacemaker implantation. An effective left and right atrial mechanical function was detected in 70-90%, and 96-98% of patients with sinus rhythm respectively. The following circumstances were identified as negative predictors of the presence of sinus rhythm after the ablation procedure: growing diameter of the left atrium, the duration of atrial fibrillation and the severity of mitral and tricuspid regurgitation before surgery (p<0.05). Restoration of the left atrial transport function was negatively predicted by the preoperative diameter of the left atrium, the presence of mitral valve stenosis and the severity of tricuspid regurgitation (p<0.05). A total of 95.4% of patients were free from stroke at one-year follow-up, and 94.1% at 2 years after surgery.Conclusion. Stable sinus rhythm and effective left atrial transport function are the main factors resulting in decreased morbidity after successful ablation of atrial fibrillation. A careful post-operative follow-up of the patients and individualised treatment are necessary.

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“…Postoperative arrhythmias may include transient and self-limited or sustained atrial fibrillation [1][2][3][4][5][6][7][8][9][10][11][12] or regular tachycardias related to macroreentry or focal mechanisms. [13][14][15] Other than typical atrial flutter, the most commonly reported reentrant tachycardia after surgery for atrial fibrillation involves the coronary sinus musculature to support reentry around the mitral valve annulus.…”

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confidence: 99%

Proarrhythmic Aspects of Atrial Fibrillation Surgery

et al. 2008

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Background-Surgery for the treatment of atrial fibrillation may be associated with early or late postoperative atrial arrhythmias. In many cases, the arrhythmias that occur early in the postoperative course may be related to pericardial inflammation or increased catecholamine levels and tend to resolve without further therapy. In contrast, late postoperative arrhythmias often are persistent, highly symptomatic, and refractory to medical therapy. The incidence and mechanisms of these late atrial arrhythmias have not been thoroughly described. Methods and Results-In this study, a total of 143 consecutive patients undergoing atrial fibrillation surgery from 1996 to 2005 were prospectively followed up. Sustained atrial tachycardia developed in 22 of 143 patients (15%) Ͼ8 weeks after the surgical procedure. These patients underwent electrophysiological study. A total of 25 separate tachycardias were mapped in these 22 patients, including 15 located in right atrium and 10 in the left atrium. Right atrial tachycardias included cavotricuspid isthmus-dependent atrial flutter (nϭ7), non-isthmus-dependent right atrial reentry (nϭ7), and 1 focal atrial tachycardia. Left atrial tachycardias included reentry around the mitral valve (nϭ3) and in the roof of the left atrium (nϭ7). All tachycardias were successfully treated with radiofrequency catheter ablation with no recurrences in long-term follow-up. Conclusions-Postoperative arrhythmias are not uncommon late after surgery for atrial fibrillation and typically are reentrant and related to surgically created boundaries. Radiofrequency catheter ablation is highly effective in the management of these late arrhythmias.

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Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation

Abstract: This pilot study demonstrates the effectiveness and safety of maze III surgery for lone PAF. In patients without sick-sinus syndrome, this intervention offers a sensible alternative to His bundle ablation and lifelong pacemaker dependency.

Cited by 77 publications

References 30 publications

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Proarrhythmic Aspects of Atrial Fibrillation Surgery

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