Abstract
Introduction
The maze procedure is the only surgical treatment that can alleviate the three physiologic sequelae of atrial fibrillation i.e. tachycardia, thromboembolic events and hemodynamic compromise. In the present study, we attempted ablation of atrial fibrillation (AF) using monopolar conventional cautery.
Objective
is to demonstrate efficacy of electroxcautery maze in chronic AF in patients undergoing mitral valve surgery and long term efficacy of it in maintaining sinus rhythm.
Methods
In this series 25 patients who underwent electrocautery maze since 2002 were studied, the age ranged from 20–60 years, 60% of patients were females. 20 patients were in NYHA class IV and 5 patients were in class III, who had left atrium (LA) ranging from 5–6.5 cms with LA appendage clot in 8 patients. All patients underwent mitral valve replacement, 3 patients under went tricuspid valve repair and 2 underwent aortic valve replacement as concomitant procedures. The electrocautery maze was done encircling left & right pulmonary veins along with interconnecting portion. Left atrial appendage was ligated only in cases with LA clot.
Results
The hospital mortality rate was nil in this group of patients. Freedom from atrial fibrillation or atrial flutter was 92% at 6mths followup. Patients were followed up with regular electrocardiography.
Conclusion
Electrocautery maze procedure, an adjunctive procedure is safe, time sparing & effective in eliminating atrial fibrillation & restoring atrial transport function.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cox JL, Schuessler RB, D’Agostino HJ, Jr., et al. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedures. J Thorac Cardiovasc Surg 1991; 101: 569–83.
Cox JL, Boineau JP, Schuessler RB, Jaquiss RDB, Lappas DG. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg 1995; 110: 473–84.
Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 1991; 101: 584–92.
Cox JL, Jaquiss RDB, Schuessler RB, Boinau JP. Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of themaze III procedure. J Thorac Cardiovasc Surg 1995; 110: 485–95.
Pasic M, Musci M, Siniawski H, Edelmann B, Tedoria T, Hetzer R. Transient sinus node dysfunction after the Cox-maze III procedure in patients with organic heart disease and chronic fixed atrial fibrillation. J Am Coll Cardiol 1998; 32: 1040–47.
Pasic M, Musci M, Siniawski H, Grauhan O, et al. The Cox-maze procedure: parallel normalization of sinus node dysfunction, improvement of atrial function, and recovery of the cardiac autonomic nervous system. J Thorac Cardiovasc Surg 1999; 118: 287–96.
Pasic M, Musci M, Edelmann B, Siniawski H, Bergs P, Hetzer R. Identification of p waves after the Cox-maze procedure: significance of right precordial leads V3R through V6R. Ann Thorac Surg 1999; 67: 1292–94.
Chen MC, Guo BF, Chang JP, Yeh KH, Fu M. Radiofrequency and cryoablation of atrial fibrillation in patients undergoing valvular operations. Ann Thorac Surg 1998; 65; 1666–72.
Melo J, Adragao PR, Neves J, et al. Electrosurgical treatment of atrial fibrillation with a new intraoperative radiofrequency ablation catheter. Thorac Cardiovasc Surg 1999; 47 (Suppl): 3 70–72.
Melo J, Adragao PR, Neves J, et al. Surgery for atrial fibrillation using radiofrequency catheter ablation: assessment of results at one year. Eur J Cardiothorac Surg 1999; 15: 851–54.
Benussi S, Pappone C, Nascimbene S, et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach. Eur J Cardiothorac Surg 2000; 17: 524–29.
Melo J, Adragao P, Neves J, et al. Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intraoperative device. Eur J Cardiothorac Surg 2000; 12: 182–86.
Patwardhan AM, Dave HH, Tamhane AA, et al. Intraoperative radiofrequency microbipolar coagulation to replace incisions of maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease. Eur J Cardiothorac Surg 1997; 12: 627–33.
Mottkamp H, Hindricks G, Hammel D, et al. Intraoperative radiofrequency ablation of chronic atrial fibrillation: a left atrial curative approach by elimination of anatomic “anchor” reetrant circuits. J Cardiovasc Electrophysiol 1999; 10: 772–80.
Sie HT, Beukema WP, Ramdat Misier AR, Elvan A, Ennema JJ, Wellens HJ. The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open-heart surgery. Eur. J Cardiothorac Surg 2001; 19: 443–47.
Pritchett EL. Management of atrial fibrillation. N England J Medicine 1992; 326: 1264–71.
Horowitz LN, Spielman SR, Greespan AM, et al. Use of amiodarone in the treatment of persistent and paroxysmal atrial fibrillation resistant to quinidine therapy. J Am College of Cardiol 1985; 6: 1402–07.
Josephson ME. Antiarrhythmic agents and the danger of proarrhythmic events. Ann Intern Med 1989; 111: 101–03.
Kogure S, Yamamoto Y, Tomono S, Hasegawa A, Suzuki T, Murata K. High risk of systemic embolism in hypertrophic cardiomyopathy. Jpn Heart J 1986; 27: 475–80.
Repique LJ, Shah SN, Maris GE. Atrial fibrillation 1992; management strategies in flux. Chest 1992; 101: 1095–03.
Cairns JA, Connolly SJ. Nonrheumatic atrial fibrillation, risk of stroke and role of antithrombotic therapy. Circulation 1991; 84: 469–81.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Inamdar, A., Reddy, P., Inamadar, S. et al. Electrocautery maze in chronic atrial fibrillation: An early experience. Indian J Thorac Cardiovasc Surg 21, 9–14 (2005). https://doi.org/10.1007/s12055-005-0063-x
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12055-005-0063-x