title: Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery.
abstract: BACKGROUND
  Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF.
  
  
  METHODS
  Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography.
  
  
  RESULTS
  The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05).
  
  
  CONCLUSIONS
  In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function.
authors.affiliation: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Sr. Registrar, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India. Electronic address: drsajidanwar@rediffmail.com.
authors.forename: Sajid A
authors.initials: SA
authors.lastname: Sayed
authors.affiliation: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Sr. Registrar, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Katewa
authors.affiliation: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Sr. Registrar, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Srivastava
authors.affiliation: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Assistant Professor, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
authors.forename: Sujit
authors.initials: S
authors.lastname: Jana
authors.affiliation: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Former Professor and Head, Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M), India; Professor, CVTS, J. N. Med. College, Sawangi, Wardha (M), India.
authors.forename: Anil M
authors.initials: AM
authors.lastname: Patwardhan
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: AF; Arrhythmia therapy (radial approach, Maze); Rheumatic disease