Surgical stratification of patients with atrial fibrillation secondary to organic cardiac lesions

• Published in: European journal of cardio-thoracic surgery Vol. 10; no. 11; pp. 983 - 989
• Main Authors: Kawaguchi, A T, Kosakai, Y, Isobe, F, Sasako, Y, Eishi, K, Nakano, K, Kobayashi, J, Kawashima, Y
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 1996
• Subjects: Adult; Aged; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Female; Heart Atria - pathology; Heart Atria - surgery; Heart Defects, Congenital - complications; Heart Valve Diseases - complications; Humans; Male; Methods; Middle Aged; Multivariate Analysis; Myocardial Ischemia - complications; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(96)80401-5

BACKGROUND: While the maze procedure does not always eliminate atrialfibrillation (AF) secondary to organic cardiac lesions, concomitantperformance of the procedure is associated with increased surgicalcomplexity and potential risks. METHODS: To stratify the surgical approachfor patients with AF secondary to underlying cardiac lesions, we analyzed24 preoperative and perioperative variables in 115 consecutive patientswith AF undergoing a modified maze procedure combined with valvularintervention (101), repair of congenital anomalies (13) and coronaryrevascularization (1). RESULTS: Patients who remained in AF (18) comparedto patients with restored atrial rhythm (97), had a higher incidence ofgiant left atrium (56% vs 10%, P < 0.0001), larger cardiothoracic ratio(70 +/- 13 vs 62 +/- 8%, P = 0.001) and left atrial dimension (64 +/- 12 vs55 +/- 12 mm, P = 0.004), a longer history of AF (13.7 +/- 6.8 vs 8.3 +/-6.9 years, P = 0.003) and lower f-wave voltage (0.10 vs 0.15 mV, P =0.004). Multivariate logistic regression analysis of 24 preoperative andperioperative variables identified the presence of giant left atrium,cardiothoracic ratio and age at operation as the significant risk factorspredisposing patients to persistent postoperative AF. Retrospectiveestimation identified 73 (63.5%) patients with a high probability of atrialdefibrillation (97.3%) and 42 (36.5%) patients with a high risk of failure(38.1%). Regardless of the preoperative risk analysis or the performance ofleft atrial plication, every patient with a postoperative left atrialdimension less than 40 mm or cardiothoracic ratio below 55% wassuccessfully defibrillated. CONCLUSION: The results suggest performing themaze procedure before "risk factors" develop for patients with predictedmaze-amenable AF. While omitting the maze procedure may be prudent forpatients with suspected maze-refractory AF, the simultaneous reduction ofleft atrial size may offset the increased risk from preoperative sizefactors. A prospective study seems warranted to examine the effects of leftatrial plication on postoperative rhythm.