title: Can we change the operative criteria for the MAZE procedure combined with valve surgery in the era of radiofrequency devices?
abstract: OBJECTIVE
  After radiofrequency (RF) ablation became available, the indication of MAZE procedure conducted with bipolar RF was expanded. We examined the efficacy and feasibility of the RF MAZE procedure in valve surgery and identified the predictors of atrial fibrillation (AF) recurrence.
  
  
  METHODS
  Forty-four patients had permanent AF at the time of operation and underwent a biatrial RF MAZE procedure. Univariate and multivariate analysis for the predictor of permanent AF recurrence and follow-up studies were performed.
  
  
  RESULTS
  Of the patients, 37 (84.1%) were in non-AF rhythm at discharge and 25 (80.6%) were at the latest follow-up (mean, 2.1 ± 1.2 years). In stepwise multivariate analysis, left atrial dimension (LAD) > 61.5 mm was an independent predictor of early-term recurrence of AF (P = 0.006) and late-term recurrence (P = 0.038) as well. F-wave voltage <0.1 mV was significant in univariate analysis but was not significant in multivariate analysis for predictor of late-term AF recurrence. Avoidance of AF in the late term was 56% for LAD > 60 mm whereas it was 91% for LAD ≤ 60 mm (P = 0.043), 67% for F-wave < 0.1 mV compared to 100% for F-wave ≥ 0.1 mV (P = 0.031), and 43% for LAD > 60 mm and F-wave < 0.1 mV compared to 91% for LAD ≤ 60 mm and/or F-wave ≥ 0.1 mV (P = 0.016), respectively. Although avoidance of AF in the late term was lower in patients with LAD > 60 mm or F-wave < 0.1 mV, more than half of these patients were free from AF in the late term.
  
  
  CONCLUSIONS
  LA size was assumed to be a simple and strong predictor of recurrent AF in this procedure. Predictive criteria that had been widely employed for the "cut-and-sew" MAZE procedure accompanied with valve surgery can be expanded in the MAZE procedure with RF devices.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan. suguru-k@med.hokudai.ac.jp
authors.forename: Suguru
authors.initials: S
authors.lastname: Kubota
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugiki
authors.forename: Satoru
authors.initials: S
authors.lastname: Wakasa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Ooka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tachibana
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Sasaki
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors