Atrial tachyarrhythmias after the maze procedure: incidence and prognosis
Yosuke Ishii1, Marye J Gleva, M Carolyn Gamache
1Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Mo, USA.
Insights
Atrial tachyarrhythmias (ATA) affect 43% of patients post-Maze procedure, typically occurring within 8 days and resolving within 3 weeks. Early ATA does not predict late atrial fibrillation recurrence.
Area of Science:
- Cardiac Surgery
- Electrophysiology
- Arrhythmology
Background:
- The Maze procedure is effective for restoring normal sinus rhythm.
- Atrial tachyarrhythmias (ATA) are frequent early complications following Maze surgery.
- Understanding ATA's incidence and natural history post-Maze is crucial.
Purpose of the Study:
- To determine the incidence of early postoperative ATA after the Maze procedure.
- To describe the natural history and resolution patterns of ATA.
- To investigate the relationship between early ATA and late atrial fibrillation recurrence.
Main Methods:
- Retrospective review of medical records for 200 patients undergoing Maze procedures (I, II, III) from 1987-2002.
- Analysis of all early postoperative ATA episodes within 30 days of surgery.
- Independent review of postoperative 12-lead electrocardiograms by two electrophysiologists.
Main Results:
- ATA occurred in 86 patients (43%), with atrial fibrillation (AF) in 59%, atrial flutter (AFL) in 14%, and both in 27%.
- Peak incidence of ATA was on postoperative day 8; average duration was 5.7 days.
- Late AF recurrence (>1 year) showed no significant difference between patients with or without early ATA (7.0% vs 8.8%, P=0.8).
Conclusions:
- Early postoperative ATA is common (43%) after Maze procedures, primarily occurring within 8 days.
- Most ATA episodes resolve within approximately 3 weeks.
- The presence of early postoperative ATA does not correlate with late recurrence of atrial fibrillation.
Background:
The Maze procedure restores normal sinus rhythm in the majority of patients. However, atrial tachyarrhythmias (ATA) are a common early complication after the operation. The purpose of this study was to define the incidence and natural history of ATA after the Maze procedure.
Methods:
Complete medical records from 200 patients who underwent the Maze procedures (I, II, and III) from 1987 to 2002 were examined for all episodes of early postoperative ATA that occurred during the first 30 days after the procedure. Two electrophysiologists independently reviewed all postoperative 12-lead electrocardiograms.
Results:
ATA occurred in 86 patients (43%) after the Maze procedure. Of the patients with ATA, 59% had atrial fibrillation (AF), 14% had atrial flutter (AFL), and 27% had both AF and AFL. Of the patients with AF or AFL, 20% and 5%, respectively, also had episodes of atrial tachycardia and supraventricular tachyarrhythmia. The peak incidence of early postoperative ATA was on postoperative day 8. The average duration of ATA was 5.7+/-5.0 days. Late recurrence of AF (>1 year postoperatively) occurred in 7.0% of patients who had early postoperative ATA and 8.8% of patients without early postoperative ATA (P=0.8).
Conclusions:
ATA occurred in 43% of patients after the Maze procedure. The tachyarrhythmias occurred primarily within 8 days after surgery and resolved within 3 weeks in almost all patients. There was no relationship between the incidence of early postoperative ATA and the late recurrence of AF.
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