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Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations
Insights
Restoring sinus rhythm after the maze procedure is more likely with a fine atrial fibrillatory wave and less likely with an enlarged left atrial diameter. These factors predict successful outcomes in cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Persistent atrial fibrillation and sick sinus syndrome can occur after the maze procedure.
- Identifying predictors for sinus rhythm restoration is crucial for patient outcomes.
Purpose of the Study:
- To identify predictors of sinus rhythm restoration following the maze procedure.
- To analyze factors influencing successful cardiac rhythm management post-operation.
Main Methods:
- Retrospective analysis of 96 patients undergoing maze procedure (maze III) with other cardiac operations (March 1993-June 1995).
- Exclusion of non-survivors and patients requiring permanent pacemakers.
- Ambulatory electrocardiographic monitoring at 1 year post-operation.
- Multiple logistic regression analysis to determine predictors of sinus rhythm restoration.
Main Results:
- Sinus rhythm was restored in 79.1% (68/86) of patients.
- A fine atrial fibrillatory wave (< 1.0 mm) positively predicted sinus rhythm restoration.
- Enlarged left atrial diameter (> or = 65 mm) was inversely related to sinus rhythm restoration.
- The odds ratio for sinus rhythm restoration with both a fine wave and enlarged left atrium was 0.04.
Conclusions:
- Atrial fibrillatory wave magnitude and left atrial diameter are independent predictors of sinus rhythm restoration after the maze procedure.
- These findings aid in predicting outcomes for patients with chronic atrial fibrillation and organic heart disease undergoing cardiac surgery.
Background:
There have been sporadic cases of persistent atrial fibrillation and sick sinus syndrome after the maze procedure. The purpose of this study was to identify the predictors of sinus rhythm restoration after operation.
Methods:
Between March 1993 and June 1995, we evaluated retrospectively 96 consecutive patients who underwent the maze procedure (maze III) in combination with another type of cardiac operation. Four patients who died and 6 patients who required permanent pacemaker implantation because of sick sinus syndrome were excluded. Ambulatory electrocardiographic monitoring was evaluated 1 year after operation. Multiple logistic regression analysis was applied to identify the predictors of sinus rhythm restoration.
Results:
The final population comprised 86 patients (mean age, 59.8 years; 67 patients with mitral valve disease). Overall, sinus rhythm was restored in 68 of 86 patients (79.1%). The magnitude of the atrial fibrillatory wave positively predicted postoperative sinus rhythm restoration. Conversely, left atrial diameter was inversely related to postoperative sinus rhythm restoration. The odds ratio of having both a fine atrial fibrillatory wave (< 1.0 mm) and enlarged left atrial diameter (> or = 65 mm) for patients with sinus rhythm restoration was 0.04 (95% confidence interval, 0.01 to 0.28).
Conclusions:
Atrial fibrillatory wave and left atrial diameter were independent predictors of sinus rhythm restoration after the maze procedure in patients with chronic atrial fibrillation and organic heart disease.