Skip to main content
SpringerLink
Log in

Role of the Simultaneous Sequential Strategy for Failed Acute Sinus Restoration after Modified Left Maze Procedure for Persistent Atrial Fibrillation with Concomitant Mitral Surgery

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

We assessed whether the simultaneous sequential strategy could (1) achieve additional sinus restoration for those patients who were not in sinus rhythm while coming off bypass after modified left maze procedure and (2) attain the same long-term success rates as the bi-atrial maze procedure in patients with persistent atrial fibrillation (AF) and mitral valve disease.

Materials and Methods

Twenty-seven consecutive patients – ten men and 17 women with a mean age of 52 ± 13 years, all with persistent AF and mitral valve disease – underwent the modified maze procedure with the simultaneous sequential strategy. In the first phase, the modified left atrial maze operation was carried out with concomitant valvular surgery; the right side maze operation was subsequently carried out as a second phase of the sequential strategy only if AF re-appeared following the spontaneous restoration of heart beats during the operation.

Results

Twenty patients (74.1%) underwent the left atrial maze procedure only, and seven patients (25.9%) required the subsequent right atrial maze procedure as part of the sequential strategy. At a mean follow-up of 15.1 ± 7.7 months, six of the 27 patients (22.2%) who underwent additional right atrial maze procedure had restored sinus rhythm. At a mean follow-up of 17.8 ± 7.3 months, 24 of the 27 patients (88.9%) had restored sinus rhythm and 22 patients (81.5%) had restored bi-atrial transport function (right atrial filling fraction: 40.8 ± 11.7%; left atrial filling fraction: 22.9 ± 8.1%) after application of the sequential strategy.

Conclusions

Compared with modified left atrial maze procedure, the application of the simultaneous sequential strategy successfully restored sinus rhythm in an additional 22.2% of patients with persistent AF. The overall sinus conversion rate of 88.9% was comparable with that of the standard bi-atrial maze procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.
Figure 2.

Similar content being viewed by others

Abbreviations

AF:

atrial fibrillation

RF:

radiofrequency

References

  1. Chesebro JH, Fuster V, Halperin JL. Atrial fibrillation – risk marker for stroke. N Engl J Med 1990;323:1556–1558

    Article  PubMed  CAS  Google Scholar 

  2. Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham heart study. Circulation 1998;98:946–952

    PubMed  CAS  Google Scholar 

  3. Cox JL, Boineau JP, Schuessler RB, et al. Successful surgical treatment of atrial fibrillation: review and clinical update. JAMA 1991;266:1976–1980

    Article  PubMed  CAS  Google Scholar 

  4. Cox JL, Boineau JP, Schuessler RB, et al. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg 1995;110:473–484

    Article  PubMed  CAS  Google Scholar 

  5. Cox JL, Jaquiss RDB, Schuessler RB, et al. Modification of the maze procedure for atrial flutter and atrial fibrillation: II. surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 1995;110:485–495

    Article  PubMed  CAS  Google Scholar 

  6. Kosakai Y, Kawaguchi AT, Isobe F, et al. Modified maze procedure for patients with atrial fibrillation undergoing simultaneous open heart surgery. Circulation 1995;92 [Suppl 2]:359–364

    Google Scholar 

  7. Imai K, Sueda T, Orihashi K, et al. Clinical analysis of results of a simple left atrial procedure for chronic atrial fibrillation. Ann Thorac Surg 2001;71:577–581

    Article  PubMed  CAS  Google Scholar 

  8. Chen MC, Chang JP, Guo GB, et al. Atrial size reduction as a predictor of the success of radiofrequency maze procedure for chronic atrial fibrillation in patients undergoing concomitant valvular surgery. J Cardiovasc Electrophysiol 2001;12:867–874

    Article  PubMed  CAS  Google Scholar 

  9. Chen MC, Chang JP, Chang HW. Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery. Chest 2004;125:2129–2134

    Article  PubMed  Google Scholar 

  10. Sie HT, Beukema WP, Elvan A, et al. Long-term results of irrigated radiofrequency modified maze procedure in 200 patients with concomitant cardiac surgery: six years experience. Ann Thorac Surg 2004;77:512–516

    Article  PubMed  Google Scholar 

  11. Sie HT, Beukema WP, Ramdat Misier AR, et al. Radiofrequency modified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery. J Thorac Cardiovasc Surg 2001;122:249–256

    Article  PubMed  CAS  Google Scholar 

  12. Wyse DG, Waldo AL, DiMacro JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825–1833

    Article  PubMed  CAS  Google Scholar 

  13. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834–1840

    Article  PubMed  Google Scholar 

  14. Boineau JP, Canavan TE, Schuessler RB, et al. Demonstration of a widely distributed pacemaker complex in the human heart. Circulation 1988;77:1221–1237

    PubMed  CAS  Google Scholar 

  15. Chen MC, Chang JP, Chen CJ, et al. Atrial pacemaker complex preserved radiofrequency maze procedure reducing the incidence of sick sinus syndrome in patient with atrial fibrillation. Chest 2005;128:2571–2575

    Article  PubMed  Google Scholar 

  16. Feinberg MS, Waggoner AD, Kater KM, et al. Restoration of atrial function after the maze procedure for patients with atrial fibrillation: assessment by Doppler echocardiography. Circulation 1994;90:285–292

    Google Scholar 

  17. Yuda S, Nakatani S, Isobe F, et al. Comparative efficacy of the maze procedure for restoration of atrial contraction in patients with and without giant left atrium associated with mitral valve disease. J Am Coll Cardiol 1998;31:1097–1102

    Article  PubMed  CAS  Google Scholar 

  18. Usui A, Inden Y, Mizutani S, et al. Repetitive atrial flutter as a complication of the left-sided simple maze procedure. Ann Thorac Surg 2002;73:1457–1459

    Article  PubMed  Google Scholar 

  19. Golovchiner G, Mazur A, Kogan A, et al. Atrial flutter after surgical radiofrequency ablation of the left atrium for atrial fibrillation. Ann Thorac Surg 2005;79:108–112

    Article  PubMed  Google Scholar 

  20. Deneke T, Khargi K, Grewe PH, et al. Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery: safety and efficacy. J Am Coll Cardiol 2002;39:1644–1650

    Article  PubMed  Google Scholar 

  21. Morady F. Catheter ablation of supraventricular arrhythmias: state of the art. J Cardiovasc Electrophysiol 2004;15:124–139

    PubMed  Google Scholar 

  22. Cappato R, Negroni S, Pecora D, et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation 2003;108:1599–1604

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan, Republic of China

    Jen-Ping Chang MD & Chiung-Lun Kao MD

  2. Division of Cardiology, College of Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan, Republic of China

    Mien-Cheng Chen MD, Cheng-Hsu Yang MD, Teng-Hung Yu MD & Chien-Jen Chen MD

  3. Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan, 83301, Republic of China

    Jen-Ping Chang MD

Authors
  1. Jen-Ping Chang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mien-Cheng Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiung-Lun Kao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng-Hsu Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teng-Hung Yu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chien-Jen Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jen-Ping Chang MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, JP., Chen, MC., Kao, CL. et al. Role of the Simultaneous Sequential Strategy for Failed Acute Sinus Restoration after Modified Left Maze Procedure for Persistent Atrial Fibrillation with Concomitant Mitral Surgery. World J. Surg. 30, 1802–1808 (2006). https://doi.org/10.1007/s00268-006-0382-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-006-0382-0

Keywords

Search

Navigation