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Published on: February 11, 2022
[Long-term Outcomes of the Maze Procedure Omitting the Ablation Line to The Superior Vena Cava]
Daisuke Takahashi1, Norihiko Shiiya, Naoki Washiyama
1Department of First Surgery, Hamamatsu University, Hamamatsu, Japan.
Insights
Omitting the superior vena cava ablation line in the Cox-maze III procedure effectively reduces sick sinus syndrome (SSS) risk. Long-term results show high freedom from atrial fibrillation and permanent pacemaker implantation.
Area of Science:
- Cardiac Surgery
- Electrophysiology
- Atrial Fibrillation Ablation
Context:
- Persistent atrial fibrillation (Af) management often involves the Cox-maze III procedure.
- Sick sinus syndrome (SSS) is a potential complication of the standard Cox-maze III lesion set.
- Modifications to the Cox-maze III procedure aim to improve patient outcomes and reduce complications.
Purpose:
- To evaluate the long-term efficacy and safety of a modified Cox-maze III procedure that omits the superior vena cava (SVC) ablation line.
- To assess the incidence of SSS and the need for permanent pacemaker implantation (PPI) after this modified procedure.
- To determine freedom from Af and survival rates in patients undergoing the modified bi-atrial maze procedure.
Summary:
- A bi-atrial maze procedure was performed on 102 patients with persistent Af, excluding the SVC ablation line.
- The study reported 5-year survival rates of 96% and freedom from Af of 88%.
- Freedom from permanent pacemaker implantation was 83% at 5 years, suggesting comparable outcomes to standard Cox-maze III.
Impact:
- This modified Cox-maze III approach may offer a viable alternative for persistent Af treatment, potentially reducing SSS incidence.
- The findings support the hypothesis that SSS in maze procedures may be patient-dependent rather than solely technique-dependent.
- Further research could explore patient-specific factors influencing SSS development post-ablation.
Objective:
In an effort to avoid postoperative sick sinus syndrome( SSS), we omit the ablation line to the superior vena cava( SVC) in the Cox-mazeⅢ lesion set. We report the long-term outcomes, including the freedom from SSS.
Methods:
We studied 102 patients who underwent bi-atrial maze procedure for persistent atrial fibrillation (Af) from 2009 through 2023. Bipolar radio frequency ablation or cryoablation was used except for right-side atriotomy and right atriotomy. Cryoablation was used for atrioventricular annulus. The patient age was 68±9.4. Duration of Af was 3.4±6.5 years (unknown 9 cases). The amplitude of f-wave in V1 was 0.182±0.095 mV and it was<0.1 mV in 19 (18.6%). Diameter of the left atrium was 50±8.9 mm, and left atrial volume index was 89±37 ml/m2. Ninety-one (89.2%) patients underwent concomitant mitral valve surgery.
Results:
Survival rate was 99% at 1 year and 96% at 5 years. Freedom from Af was 92% at 1 year and 88% at 5 years. Freedom from permanent pacemaker implantation (PPI) was 87% at 1 year and 83% at 5 years.
Conclusions:
Defibrillation rate and the incidence of PPI was comparable to those in previous reports after standard Cox-mazeⅢ. SSS after maze for persistent Af seem due to patient.
