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Related Experiment Videos

Sinus node function after cardiac surgery: is impairment specific for the maze procedure?

Anton E Tuinenburg1, Isabelle C Van Gelder, Maarten P Van Den Berg

  • 1Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. a.e.tuinenburg@thorax.azg.nl

International Journal of Cardiology
|May 26, 2004
PubMed
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Cardiac surgery, including maze and valve procedures, can impair sinus node function and heart rate variability. Recovery occurs over 12 months, with atrial incision being a key factor.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Maze surgery is a definitive treatment for intractable atrial fibrillation (AF).
  • Concerns exist regarding Maze surgery's impact on postoperative sinus node function.
  • The effect of other cardiac surgeries on sinus node function is not well understood.

Purpose of the Study:

  • To investigate the impact of different cardiac surgeries on sinus node function and autonomic modulation.
  • To compare the effects of Maze III, combined Maze-valve surgery, isolated valve surgery, and coronary artery bypass grafting (CABG) on heart rate variability (HRV) and autonomic function.

Main Methods:

  • Assessed postoperative rhythm using exercise tolerance testing, ambulatory ECG, and non-invasive autonomic function testing.

Related Experiment Videos

  • Evaluated 14 patients undergoing Maze III, 11 undergoing combined Maze-valve surgery, 8 undergoing isolated valve surgery, and 8 undergoing CABG.
  • Follow-up assessments were conducted between 1 and 12 months post-surgery.

    • Main Results:

    • Postoperative heart rate variability (HRV) was reduced, and chronotropic response to exercise was depressed 1 month after Maze III, combined, and isolated valve surgeries.
    • Moderate improvements in HRV and sinus node function were observed by 12 months.
    • Coronary artery bypass grafting (CABG) showed fewer abnormalities and better HRV recovery compared to procedures involving atrial incision.
    • Non-invasive autonomic testing revealed disturbed vagal modulation in all groups with atrial incision.

    Conclusions:

    • Impaired HRV and vagal modulation of sinus node function are not exclusive to Maze surgery but also occur after isolated mitral valve surgery.
    • Atrial incision is likely responsible for autonomic nervous damage, followed by partial reinnervation.
    • Cardiac surgery, in general, initially impairs sinus node function, with partial recovery over 12 months.