title: Long-term follow-up after the mini-maze procedure.
abstract: BACKGROUND
  Atrial fibrillation (AF) is associated with significant morbidity and mortality. The standard to treat AF surgically is the Cox maze III procedure but owing to its complexity it is not performed on a regular basis. Meanwhile several maze variants have been developed but their long-term results are still not well known.
  
  
  METHODS
  From November 1995 until May 2002 a mini-maze procedure was performed upon 77 patients aged 64 +/- 8.7 years with chronic symptomatic AF. Electrophysiological evaluation, magnetic resonance imaging, echocardiography and electrocardiographic evaluations were performed after 3 and 12 months. After a mean follow-up of 50 +/- 2.6 months a standard questionnaire was sent to all patients.
  
  
  RESULTS
  Early and late mortality was 1.2% and 9.3% respectively. Actuarial survival was 91%, 90%, and 87% after 1, 3, and 5 years respectively. Left bundle branch block was an independent risk factor for late death (p = 0.02). Patients who were in sinus rhythm at follow-up had significantly better survival rate as compared with the patients still in AF. Seventy-one percent of patients were in sinus rhythm or paced by an atrial pacemaker. Predictors for restoration of sinus rhythm were absence of preoperative mitral insufficiency (p = 0.03) and larger left atrium (p = 0.04). The presence of preoperative tricuspid insufficiency (p = 0.03) and larger right atrium (p = 0.017) were predictors for postoperative pacemaker implantation.
  
  
  CONCLUSIONS
  The mini-maze procedure can be carried out with satisfactory early and long-term results regarding mortality and restoration of sinus rhythm. Prophylactic implantation of biventricular pacemakers in patients with left bundle branch block may decrease late mortality. Every effort should be done to cure AF as it affects long-term survival.
authors.affiliation: Department of Cardiovascular Surgery, Kerckhoff-Clinic Foundation, Bad Nauheim, Germany.
authors.forename: Zoltan A
authors.initials: ZA
authors.lastname: Szalay
authors.forename: Ali
authors.initials: A
authors.lastname: Civelek
authors.forename: Thorsten
authors.initials: T
authors.lastname: Dill
authors.forename: Wolf Peter
authors.initials: WP
authors.lastname: Klövekorn
authors.forename: Iram
authors.initials: I
authors.lastname: Kilb
authors.forename: Erwin P
authors.initials: EP
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome