title: Surgical Treatment of Concomitant Atrial Fibrillation: Focus onto Atrial Contractility.
abstract: BACKGROUND
  Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation.
  
  
  METHODS
  122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied.
  
  
  RESULTS
  At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes.
  
  
  CONCLUSIONS
  SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia "chronic state" (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and "kick" restoring and an influence of RA contraction onto LV function.
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Loardi
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Galli
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Moreno
authors.initials: M
authors.lastname: Naliato
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Parea 4, 20138 Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology*; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012307:Risk Factors; D014463:Ultrasonography