Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease

Institute of Pathology, Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany
European Heart Journal (Impact Factor: 15.2). 04/2002; 23(7):558-66. DOI: 10.1053/euhj.2001.2841
Source: PubMed


This study is the first prospective randomized trial evaluating the efficacy of an antiarrhythmic surgical procedure in patients with chronic atrial fibrillation undergoing mitral valve replacement.
Thirty consecutive patients with chronic atrial fibrillation undergoing mitral valve replacement were randomized for an additional modified MAZE-operation using intra-operatively cooled-tip radiofrequency ablation (group A) or mitral valve replacement alone (group B). Biatrial contraction was studied and functional capacity was evaluated in spiro-ergometry 6 months after surgery. Thirty-day mortality was 0% in both groups. After 12 months, sinus rhythm was reinstituted significantly more often in patients of group A (cumulative rate of sinus rhythm 0.800) compared to patients in group B (0.267) (P<0.01). 66.7% of patients in sinus rhythm of group A had documented biatrial contraction. Electrocardioversion showed long-term success in only 17% of patients in group A and 0% in group B. Maximal aerobic uptake at the 6-month spiro-ergometry revealed no significant difference (9.3 vs 8.5 ml x min(-1) kg(-1), P=0.530).
A modified MAZE operation using cooled-tip radiofrequency ablation can be safely combined with mitral valve surgery and is highly effective in restoring sinus rhythm. Biatrial contraction is found in 66.7% of patients with sinus rhythm undergoing mitral valve replacement plus the MAZE operation.

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Available from: Thomas Deneke,
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    • "AF presents with different frequencies in patients affected by structural heart diseases requiring surgery, showing a peak incidence of up to 60–80% in mitral subjects [1]. It causes an increased risk of systemic embolism, cardiac failure development, and higher limitations due to dyspnea and fatigue on exercise. "
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    ABSTRACT: . Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation. Methods . 122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied. Results . At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes. Conclusions . SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia “chronic state” (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and “kick” restoring and an influence of RA contraction onto LV function.
    08/2015; 2015(4):1-9. DOI:10.1155/2015/274817
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    • "What RFA lesions have in common in all studies is complete isolation of all the pulmonary lesions associated with at least one line drawn towards the mitral valve annulus. Deneke et al. [18] compared the outcomes of 15 patients who had a combined procedure with 15 patients who had valve surgery alone. At 12 months, 81.8% of patients with left-sided ablation were in sinus rhythm versus 21.4% in the surgery-alone group. "
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    ABSTRACT: Randomized studies evaluating left atrial radiofrequency ablation (RFA) in patients with persistent atrial fibrillation undergoing mitral valve surgery are scarce and monocentric. To evaluate the efficacy of left atrial RFA concomitant with mitral valve surgery to restore and maintain sinus rhythm. The SAFIR is a multicentre, double-blinded, centrally randomized study involving four university hospitals. Between December 2002 and September 2005, 43 patients with mitral valve disease and long-standing, persistent atrial fibrillation (duration>6 months) were included. We compared valvular surgery alone (n=22) or with left atrial RFA (n=21). The main endpoint was sinus rhythm at 12 months without recurrence of arrhythmia during follow-up. Secondary endpoints were surgical adverse events, atrial fibrillation relapses, stroke and echocardiographic measurements after three and 12 months' follow-up. Analyses of the efficacy criteria were performed on an intention-to-treat basis. The primary endpoint occurred significantly more often in the RFA group than in the control group (respectively, 12/21 patients [57%] vs 1/22 patients [4%]; p=0.004). There were more patients with sinus rhythm in the RFA group than in the control group at discharge (72.7% vs 4.8%; p<0.005), 3-month follow-up (85.7% vs 23.8%; p<0.01) and 12-month follow-up (95.2% vs 33.3%; p<0.005). The patients in the RFA group had similar rates of postoperative complications and stroke during follow-up as those in the control group. This multicentre study suggests that left atrial RFA is effective and safe in patients with chronic atrial fibrillation and mitral valve disease.
    Archives of cardiovascular diseases 11/2009; 102(11):769-75. DOI:10.1016/j.acvd.2009.08.010 · 1.84 Impact Factor
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    • "Benussi et al. have shown that all patients who recover sinus rhythm after epicardial catheter ablation and mitral surgery also recover biatrial contractility 3 months after the operation [15]. When surgical ablation was performed by the endocardial route and with unipolar radiofrequency, only 67% of patients in sinus rhythm recovered biatrial electrical conduction [16]. This difference would appear to be linked to the more limited trauma of the atrial myocardium after epicardial ablation by bipolar radiofrequency [15]. "
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    ABSTRACT: Atrial fibrillation is the most frequent form of cardiac arrhythmia. Its surgical management has improved in recent years with major advances in our knowledge of the underlying pathogenic mechanisms. This has led to simpler therapeutic strategies such as epicardial ablation. The aim of this comparative experimental study was to evaluate the efficacy of this treatment, achieved with either bipolar radiofrequency or cryoablation. Twelve sheep were used. After left thoracotomy, epicardial ablation of the junction between the left pulmonary veins and the left atrium was achieved by means of bipolar radiofrequency in group A (n=6) and by cryoablation in group B (n=6). Electrical stimulation thresholds were determined before and after ablation. Four weeks after ablation, sheep were killed for pathologic studies. The mean stimulation threshold was 3.5+/-0.6 mA before ablation and 15.6+/-5.6 mA after ablation. The difference was significant in both groups, showing that effective conduction blockade was obtained with the two ablation methods. Histologic studies after radiofrequency and cryoablation showed limited coagulation necrosis and cellular rarefaction, respecting the supportive tissue. Both methods of surgical ablation by the epicardial route yielded effective electrical isolation of the pulmonary vein junction with the left atrium. This conduction blockade was due to limited coagulation necrosis with myocyte rarefaction, of similar extents in the two procedures. Standardization and refinement of this technique could extend the treatment indications for atrial fibrillation associated with other cardiac disorders that require surgical treatment without opening the left atrium.
    Archives of Cardiovascular Diseases 11/2008; 101(11-12):763-8. DOI:10.1016/j.acvd.2008.07.004 · 1.84 Impact Factor
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