Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery. Issue 19 (2nd October 2018)

• Record Type: Journal Article
• Authors: Cho, Min Soo; Heo, Ran; Jin, Xin; Lee, Jung‐Bok; Lee, Sahmin; Kim, Dae‐Hee; Kim, Joon Bum; Kim, Jun; Jung, Sung‐Ho; Choo, Suk Jung; Song, Jong‐Min; Nam, Gi‐Byoung; Choi, Kee‐Joon; Kang, Duk‐Hyun; Chung, Cheol Hyun; Lee, Jae Won; Kim, You‐Ho; Song, Jae‐Kwan
• Is Part Of: Journal of the American Heart Association. Volume 7:Issue 19(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-10-02
• Subjects: atrial fibrillation -- maze procedure -- mitral valve surgery -- sick sinus syndrome; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.009629
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: To characterize the development of sick sinus syndrome (SSS) after the additive maze procedure (MP) during mitral valve surgery. Methods and Results: Follow‐up data (median, 3.6 years) of 750 patients with a prevalence of rheumatic cause of 57.6% were analyzed. SSS occurred in 35 patients with a time‐dependent increase: the incidence rates at 1, 2, and 4 years after surgery were 2.9%, 3.7%, and 4.3%, respectively. The additive MP showed higher risks of SSS development (hazard ratio, 7.44; 95% confidence interval, 3.45–16.05; P <0.001) and pacemaker implantation (hazard ratio, 3.61; 95% confidence interval, 1.95–6.67; P <0.001). Patients who developed SSS showed higher 4‐year rates of clinical events (death, stroke, and hospital admission) (67.5±8.5% versus 33.0±1.9%; P <0.001). After adjustment for age and preoperative peak systolic pulmonary artery pressure, the lesion extent (biatrial versus left atrial MP), not the underlying cause (rheumatic versus nonrheumatic), was independently associated with SSS development (hazard ratio, 3.58; 95% confidence interval, 1.08–11.86; P =0.037). The adverse effect of the biatrial MP was confirmed in patients with trivial or mild preoperative tricuspid regurgitation showing higher SSS incidence (4.6±1.4% versus 1.0±0.7%; P =0.023), not in those with moderate‐to‐severe tricuspid regurgitation (6.8±1.7% versus 3.8±3.8%; P =0.337). Recurrence of atrial fibrillation was not associated with the lesion extent of the MP. Conclusions: After the additive MP, the ongoing risk of SSS development should be acknowledged irrespective of the underlying cause. Considering additive risk of biatrial MP with similar atrial fibrillation recurrence rate, minimizing lesion extent is warranted.