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Medium Term Results of Cut-and-Sew MAZE III Versus Ablation Devices for the Treatment of Chronic and Paroxysmal Atrial Fibrillation
M. J. Davidson, N. Narayanasamy, S. McGurk, G. S. Couper, L. H. Cohn. Brigham and Women's Hospital, Boston, MA,
BACKGROUND: New ablation devices have simplified the treatment of atrial fibrillation (AF), but the long-term success of these therapies is unclear. We examined the effectiveness of various MAZE treatments in patients with AF undergoing other cardiac surgical procedures.
METHODS: The records of all patients undergoing AF ablation concomitant with other cardiac surgical interventions at a single institution from November 2000 to April 2005 were evaluated (n=201). Patients received either (1) a Cox MAZE III (MAZE III), (2) a modified MAZE (M-MAZE: pulmonary vein (PV) isolation, connecting lesions between PV, to mitral valve, and left atrial appendage), or (3) PV isolation (PVI) alone. M-Maze and PVI utilized either bipolar radiofrequency (n=160), cyroablation (n=24), or monopolar radiofrequency (n=9). Patients were followed up for presence of normal sinus rhythm (NSR), complications, and adjuvant therapies.
RESULTS: Preoperatively, 138 patients had chronic AF (CAF, 68.7%) and 63 patients had paroxysmal AF (PAF, 31.3%). Operative mortality was 2.0% (n=4) and late mortality was 9.6% (n=20). Follow-up rhythm assessment was available at greater than 60 day interval for 163 patients (81.1%). | | N= | NSR at follow-up | Interval (days) | Late Cardioversion | Late Catheter Ablation | Postoperative Pacemaker | | MAZE III | 13 | 61.5% | 952 ± 419 | 0.0% | 0.0% | 15.4% | | CAF | M-MAZE | 50 | 46.0% | 337 ± 232 | 34.0%† | 12.0% | 16.0% | | PVI | 48 | 29.2%* | 464 ± 261 | 16.7%* | 6.3% | 18.8% | | | | | | | | | | PAF | PVI | 52 | 73.1%** | 306 ± 171 | 23.1% | 9.6% | 15.4% | | Data = Mean ± SD; *p<0.02 vs Full MAZE and vs M-MAZE; **p<0.001 vs PVI in CAF; †p<0.02 vs Full MAZE |
CONCLUSIONS: Modified MAZE can be performed as a concomitant procedure with low operative mortality but variable clinical success, based on the lesion set used and AF chronicity. Cut-and-sew MAZE III resulted in greater restoration of NSR and less need for adjuvant procedures. Among patients in CAF, PVI alone resulted in limited success.
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