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Left and right atrial transport function after the Maze procedure for atrial fibrillation: an echocardiographic
A Albirini1, G M Scalia, R D Murray
1Cleveland Clinic Foundation, Department of Cardiology, OH 44195-5001, USA.
Insights
The Maze procedure preserves atrial function in most patients long-term, though left atrial function shows reduced velocity compared to controls. This study evaluated atrial transport function after the Maze procedure using echo Doppler techniques.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- The Maze procedure aims to restore normal sinus rhythm and preserve atrial contraction in patients with atrial fibrillation.
- While initial data suggest restored atrial transport function post-Maze, long-term evaluations are limited.
- This study addresses the need for long-term echo Doppler evaluation of atrial function after the Maze procedure.
Purpose of the Study:
- To assess long-term atrial transport function following the Maze procedure.
- To compare left and right atrial function in Maze patients with healthy controls.
- To utilize echo Doppler techniques for evaluating atrial function.
Main Methods:
- Pulsed-wave Doppler and two-dimensional echocardiography were performed on 31 Maze procedure patients (mean follow-up 16.5 months).
- Key measurements included inflow A-wave velocity, atrial areas, and fractional area change.
- Results were compared to 15 age-matched healthy control subjects.
Main Results:
- Left atrial function (presence of A-wave) was observed in 71% of patients, and right atrial function in 81%.
- Left ventricular inflow A-wave velocity was significantly lower in Maze patients compared to controls (p < 0.001).
- Right ventricular inflow A-wave velocity did not differ significantly between groups; atrial sizes decreased post-procedure.
Conclusions:
- The Maze procedure preserves left and right atrial systolic function in the majority of patients at long-term follow-up.
- Restored left atrial function, indicated by A-wave velocity, is diminished compared to controls.
- Atrial sizes decrease post-Maze, but fractional area change remains stable, suggesting effective, albeit reduced, atrial function restoration.
Objectives:
We evaluated atrial transport function after the Maze procedure in long-term follow-up and compared left and right atrial function in Maze patients with that of healthy age-matched controls using echo Doppler techniques.
Background:
The Maze procedure is designed to eliminate atrial fibrillation, restore normal sinus rhythm, and preserve atrial contraction. Initial data indicate that atrial transport function is restored in most patients undergoing the Maze procedure. The long-term echo Doppler evaluation of patients after the Maze procedure has not been well described.
Methods:
We performed pulsed-wave Doppler and two-dimensional echocardiographic studies on 31 patients (24 men, mean age 53.8 years) who underwent the Maze procedure and who had a follow-up study greater than 3 months (mean 16.5 months) after the procedure. Measurements included peak left ventricular and right ventricular inflow A-wave velocity, maximum and minimum left atrial and right atrial areas, and fractional area change of the left and right atria. Results were compared with those obtained from 15 age-matched control subjects (11 men, mean age 53.8 years).
Results:
Twenty-two patients (71%) had left atrial function shown by the presence of left ventricular inflow A-wave, and 25 patients (81%) had right atrial function shown by the presence of right ventricular inflow A-wave on Doppler echocardiography. The left ventricular inflow A-wave velocity was significantly lower than that of age-matched controls (37.5 +/- 15.5 versus 61.0 +/- 13.9 cm/sec; p < 0.001), whereas the right ventricular inflow A-wave velocity did not significantly differ between patients and control subjects (35.4 +/- 9.9 versus 35.3 +/- 4.9 cm/sec; p = Not significant). Although left and right atrial areas decreased significantly after the procedure, there was no significant change in the fractional area change which was smaller in Maze patients than control individuals.
Conclusions:
(1) In long-term follow-up of 16.5 months after the Maze procedure, left atrial systolic function was preserved in 71% of our patients and right atrial systolic function was preserved in 81%; (2) the left ventricular inflow peak A-wave velocity after Maze is considerably less than that in age-matched controls; and (3) left and right atrial sizes decreased after the procedure with no change in the fractional area change. These findings suggest that the Maze procedure is effective in restoring atrial function in the majority of patients; however, restored function is less than in control individuals.