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.
    Full-text · Article · Aug 2015
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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.
    Full-text · Article · Nov 2009 · Archives of cardiovascular diseases
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    • "Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that increases morbidity and mortality [1], and presents in up to 60—80% of patients undergoing surgery for mitral valve disease [2]. Since Cox Maze procedure was introduced by James L. Cox in 1987, surgical ablation of AF has been one of the most effective means of curing this arrhythmia. "
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    ABSTRACT: Since the late 1980s, surgical ablation of atrial fibrillation (AF) has been one of the most effective means of curing this arrhythmia. However, about 20% of patients who underwent maze procedures have shown recurrence of AF during the follow-up periods. The aim of this study is to evaluate our result of maze procedures in last decade and to analyze the risk factors of maze failure. Between July 1997 and July 2007, 560 consecutive patients underwent maze procedures for AF by a single surgeon. Demographics showed that average age of the patients is 51.3 years, with a slight female predominance (M:F = 248:312). Most of the maze procedures had been performed in conjunction with mitral valve (n = 494, 88.6%), while only six cases (1.1%) were performed with isolated maze procedure. The maze failure was defined as showing any rhythm besides normal sinus rhythm at the last follow-up. Univariate and multivariate analysis for the risk factors of maze failure were identified. The survival impact of maze failure was also evaluated. The in-hospital mortality (1.6%) was acceptable. During the 29.7 months of median follow-up period, the late mortality rate was 3.8% and permanent pacemaker insertion was necessary in 2.3% (n = 13) of the patients. The success rate of maze was 84.1% (471/560) and effective left atrial contraction was identified in 97.2% (458/471) of these patients. In multivariate analysis, the size of left atrium larger than 60 mm, cardiothoracic ratio over 60%, fine AF wave in preoperative ECG, no early normal sinus restoration and simplified surgical ablation were found as an independent predictor of maze failure. Furthermore, the patients with successful maze showed better long-term survival rates. The results of our maze procedure during the last decade showed an acceptable success rate and the patients who were restored to sinus rhythm after maze procedures showed better long-term survival rates. For the patients who have independent biological risk factors, more thorough ablation lesion set is recommended for better long-term results.
    Preview · Article · May 2009 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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