Recovery of atrial contractile function after cut-and-sew maze for long-standing persistent valvular atrial fibrillation. (1st February 2021)

• Record Type: Journal Article
• Authors: Jin, Yan; Wang, Hui-Shan; Han, Jin-Song; Zhang, Jian; Zhang, Yu-Ji; Xin, Fang-Ran; Yu, Yan; Zhao, Yang
• Is Part Of: International journal of cardiology. Volume 324(2021)
• Page Start: 84
• Page End: 89
• Publication Date: 2021-02-01
• Subjects: Atrial fibrillation -- Valvular heart disease -- Maze III procedure -- Atrial contractile function; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.010
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objective: The recovery of atrial contractile (AC) after maze has been concerned and even questioned. Now, studied the AC recovery degree and its influencing factors. Method: 237 patients with valvular long-standing persistent atrial fibrillation (AF) were retrospectively grouped according to whether sinus rhythm(SR) maintained and AC restored: SR-AC (163 cases), SR-no-AC (41 cases) and AF-no-AC (33 cases). SR-AC were grouped according to Em/Am ratio. Em/Am≤2 showed that the AC recovered well. Results: The SR maintained rate (161/177, 90.96%) in patients underwent the cut-and-sew maze III (CSM) was significantly higher than that in cryoablation (43/60, 71.7%). Preoperative AF duration had no significant difference among three groups ( P = 0.679). Maze methods had significant relationship with whether SR recovered, P < 0.05, but no significant relationship with whether AC recovered in SR maintained patients ( P = 0.280). Nearly 80% (163/204) patients can recover AC, among 156 patients (156/204, 76.5%) recovered contractile of left and right atrium, and 63 (63/204, 30.1%) recovered significant left atrial contractile, that is, Em/Am≤2. Whether AC was significantly restored was not related to maze methods, P = 0.370. AC recovered degree in rheumatic heart disease (RHD) patients was worse than that in mitral valve prolapse (MVP) patients, P = 0.004. Conclusion: To sum up, the CSM is safe and effective, and the atrial contractile function recovery was found in 80%. The key to the success of maze is to form a complete and lasting electrical isolation, and there was no difference in the rate of atrial contractile recovery when postoperative SR was maintained, no matter what maze method is used. MVP patients should be treated with maze more actively than RHD patients. Highlights: The cut-and-sew maze III is safe and effective, and the atrial contractile function recovery was found in 80%. The key to the success of maze is to form a complete and lasting electrical isolation. There is no difference in the rate of atrial contractile recovery when SR was maintained, no matter what maze method is used. Mitral valve prolapse patients should be treated with maze more actively than rheumatic heart disease patients.