Persistent atrial fibrillation is associated with inability to recover atrial contractility after MAZE IV surgery in rheumatic disease.
BACKGROUND
MAZE IV surgery is effective in restoring sinus rhythm (SR) and atrial contraction (AC) in patients with nonrheumatic persistent atrial fibrillation (AF). However, there is less information on its effectiveness to restore AC in patients with rheumatic disease.


OBJECTIVE
To assess the effectiveness of the MAZE IV surgery in restoring AC in patients with rheumatic disease and long persistent AF.


METHODS
Prospective, consecutive study in patients who underwent cardiovascular surgery and had long persistent AF in whom MAZE IV surgery was performed. The presence of AC was assessed by lateral mitral annulus tissue Doppler.


RESULTS
A total of 75 patients were included. Mean age 60 years (±11.7); 27 men (36%). AF duration was 63 months (±34.1). Primary indication for surgery: rheumatic mitral stenosis 67 patients and mitral insufficiency eight patients. Mean left ventricular ejection fraction (LVEF) was 51.8% (±12.1) and mean left atrial area was 37 cm(2) (±10.3). After a mean follow-up of 28 months (±9.3), 69 patients remained alive and 59 were in SR. AC was detected in 37.3% (Group A) and absent in 62.7% (Group B). The mean difference between groups was the high prevalence of AF longer than 5 years in group B (P = 0.000001). There were no differences related to left atrial size, LVEF, and age.


CONCLUSIONS
In patients with rheumatic disease, the absence of correlation between SR recovery and AC recovery post MAZE IV surgery is significant. A history of long persistent AF lasting more than 5 years was a strong predictor for the absence of AC.
Cardiology Division Cardiovascular Surgery, Sanatorio de la Trinidad Mitre, Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina. matiastinetti@hotmail.com
Matias
M
Tinetti
Ramiro
R
Costello
Cesar
C
Cardenas
Antonio
A
Piazza
Ricardo
R
Iglesias
Adrian
A
Baranchuk
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000601:surgery; D009200:Myocardial Contraction / Q000502:physiology*; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome