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Eur J Cardiothorac Surg 2007;32:308-312. doi:10.1016/j.ejcts.2007.02.041
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium

^a Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
^b Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

Received 4 September 2006; received in revised form 14 February 2007; accepted 15 February 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara, Sakyo, Kyoto 606-8507, Japan. Tel.: +81 75 751 3784; fax: +81 75 751 4960. (Email: komelab{at}kuhp.kyoto-u.ac.jp).

Objective: Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. Methods: The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter 60 mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). Results: Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291 ± 117 vs 223 ± 81 ml, p < 0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p < 0.05) and LAEDV was drastically smaller (118 ± 48 vs 203 ± 76 ml, p < 0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3 ± 7.8 vs 10.3 ± 4.7%, p < 0.001). Conclusions: The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.

Key Words: Cox maze • Atrial fibrillation • Magnetic resonance imaging

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