Improved neurohormonal markers of ventricular function after restoring sinus rhythm by the Maze procedure.
BACKGROUND
Clinical results of the Maze procedure for treatment of atrial fibrillation (AF) are excellent, suggesting improved ventricular function after restoring sinus rhythm. However, long-term corresponding effects on the release of cardiac natriuretic peptides and other vasoactive hormones are incompletely investigated after isolated Maze surgery.


METHODS
Plasma levels of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), antidiuretic hormone, aldosterone, and angiotensin II were measured in 15 patients (mean age, 52 +/- 11 years) undergoing isolated surgical Maze (III) procedures for medically refractory AF, preoperatively and 6 months postoperatively. At the time of blood sampling, hemodynamic correlates were obtained at baseline and after 6 and 12 minutes of rapid ventricular pacing at 150 stimulations/minute.


RESULTS
All patients were free of AF at 6-month follow-up. The measured plasma levels of BNP, ANP, and angiotensin II were all significantly lower (p = 0.03) late after the isolated Maze procedure. Cardiac output was significantly higher postoperatively (p < 0.01). Other hemodynamic values and left atrial size were unchanged after surgery. Ventricular pacing caused almost identical hemodynamic changes in atrial pressures before and late after surgery, but the associated plasma ANP response was significantly attenuated postoperatively (p < 0.001).


CONCLUSIONS
Levels of cardiac natriuretic peptides and angiotensin II as markers of ventricular function are improved in the long term after clinically successful isolated Maze procedures. ANP response to hemodynamic challenge by ventricular pacing was attenuated postoperatively, possibly due to atrial scarring.
Albåge
Anders
A
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden. anders.albage@hs.se
Kennebäck
Göran
G
van der Linden
Jan
J
Berglund
Hans
H
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood / Q000601:surgery*; D009320:Atrial Natriuretic Factor / Q000097:blood; D002908:Chronic Disease; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018377:Neurotransmitter Agents / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D014667:Vasopressins / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology*
D018377:Neurotransmitter Agents; D014667:Vasopressins; D000804:Angiotensin II; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D009320:Atrial Natriuretic Factor