Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: right-sided maze versus biatrial maze.

Abstract

BACKGROUND:

Although it has been inferred that a biatrial maze procedure for atrial fibrillation in left-sided heart lesions may lead to better outcomes compared with a limited left atrial lesion set, it remains controversial whether the biatrial maze procedure is superior to the right atrial maze procedure in right-sided heart lesions.

METHODS:

A retrospective review was performed for 56 adults who underwent surgical closure of atrial septal defect and various maze procedures for atrial fibrillation between June 1998 and February 2011. The median age at operation was 59 years (range, 34-79 years). Clinical manifestations of atrial fibrillation were paroxysmal in 8 patients, persistent in 15 patients, and long-standing persistent in 33 patients. A right atrial maze procedure was performed in 23 patients (group 1), and a biatrial maze procedure was performed in 33 patients (group 2). Treatment failure was defined as atrial fibrillation recurrence, development of atrial flutter or other types of atrial tachyarrhythmia, or implantation of a permanent pacemaker. The Cox proportional hazards model was used to identify risk factors for decreased time to treatment failure.

RESULTS:

During the median follow-up period of 49 months (range, 5-149 months), there was no early death and 1 late noncardiac death. On Cox survival model, group 1 showed a significantly decreased time to treatment failure in comparison with group 2 (hazard ratio, 5.11; 95% confidence interval, 1.59-16.44; P = .006). Maintenance of normal sinus rhythm without any episode of atrial fibrillation recurrence at 2 and 5 years postoperatively was 57% and 45% in group 1, respectively, and 82% and 69% in group 2, respectively.

CONCLUSIONS:

Left-sided ablation in addition to a right atrial maze procedure leads to better electrophysiologic outcome in atrial fibrillation associated with atrial septal defect.

• Authors: Yu-Mi Im, Joon Bum Kim, Sung-Cheol Yun, Jae Won Lee, Cheol Hyun Chung, Jeong-Jun Park, Tae-Jin Yun
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 145 Issue 3 Pg. 648-54, 655.e1; discussion 654-5 (Mar 2013) ISSN: 1097-685X [Electronic] United States
• PMID: 23312106 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Adult
• Aged
• Atrial Fibrillation (etiology, surgery)
• Cardiac Surgical Procedures (methods)
• Female
• Heart Septal Defects, Atrial (complications, surgery)
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Proportional Hazards Models
• Retrospective Studies
• Survival Rate
• Treatment Outcome