The effects of Maze procedure combined with other cardiac surgery and its modification based on the mechanism of chronic atrial fibrillation

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(1) Clinical results of Maze procedure for chronic atrial fibrillation combined with other cardiac surgery. The Maze procedure was safely combined with other cardiac surgery without adding undue operative morbidity and mortality. Seventy-three of 100 patients regained sinus rhythm, 21 patients were in atrial fibrillation and 6 patients underwent pacemaker implantation. Ambulatory electrocardiographic monitoring revealed that atrial fibrillatory wave in leads II or VI and left atrial diameter by echocardiography were independent predictors of sinus rhythm restoration early after the Maze procedure. The preoperative left atrial dimention may also be useful in predicting the restoration of postoperative atrial contractile function. In the follow-up period, some patients who regained sinus rhythm after procedure converted back to atrial fibrillation. The probability of sinus rhythm maintenance was 88.8 ± 3.7% at on year and 64.8 ± 7.5% at five years. It was suggested that gradual but constant attrition in the rate of sinus rhythm maintenance continued after the Maze procedure combined with mitral valve surgery.(2) Modification of the original Cox/Maze procedure We made left atriotomy line in Cox/Maze procedure into the simple isolation of four inlet orifices of pulmonary vein from left atrium. Because left atrial epicardial mapping study during operation showed that the firing potential usually located around the orifices of pulmonary vein. Although atrial tachyarrhythmia disappeared after the modification of left atrial incision, the rate of regaining sinus rhythm decreased. The further evaluation will be necessary to prove the efficacy of the modification.