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. 1996 Sep;224(3):267–275. doi: 10.1097/00000658-199609000-00003

An 8 1/2-year clinical experience with surgery for atrial fibrillation.

J L Cox 1, R B Schuessler 1, D G Lappas 1, J P Boineau 1
PMCID: PMC1235364  PMID: 8813255

Abstract

OBJECTIVE: The authors analyzed the clinical results during the first 8 1/2 years' experience with the Maze procedure for the surgical treatment of atrial fibrillation. SUMMARY BACKGROUND DATA: Atrial fibrillation occurs in 0.4% to 2% of the general population and in approximately 10% of patients older than 60 years of age. It is associated with significant morbidity and mortality. The irregular heartbeat causes discomfort, the loss of synchronous atrioventricular contraction compromises hemodynamics and the stasis of blood flow increases the vulnerability to thromboembolism. METHODS: From September 25, 1987 to March 1, 1996, 178 patients underwent the Maze procedure. Thirty-two patients underwent the Maze-I procedure, 15 underwent the Maze-II procedure, and 118 underwent the Maze-III procedure. Patients were analyzed for recurrence of atrial flutter and atrial fibrillation between 3 months and 8 1/2 years after surgery (n = 164). Patients were analyzed for atrial transport function, sinus nodule function, and postoperative pacemaker requirements. RESULTS: Ninety-three percent of all patients were arrhythmia free without any antiarrhythmic medication. Of the remaining patients with arrhythmia recurrence, all were converted to sinus rhythm with medical therapy. All patients were documented to have atrial transport function by either direct visualization, transesophageal echocardiography, or atrioventricular versus ventricular pacing at the same rate. Ninety-eight percent had documented right atrial function, and 94% had left atrial function. Of the 107 patients in this series who were documented to have a normal sinus node preoperatively, only 1 patient required a permanent pacemaker. CONCLUSION: The Maze procedure is an effective treatment for medically refractory atrial fibrillation in properly selected patients.

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Selected References

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  1. Cameron A., Schwartz M. J., Kronmal R. A., Kosinski A. S. Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). Am J Cardiol. 1988 Apr 1;61(10):714–717. doi: 10.1016/0002-9149(88)91053-3. [DOI] [PubMed] [Google Scholar]
  2. Canavan T. E., Schuessler R. B., Boineau J. P., Corr P. B., Cain M. E., Cox J. L. Computerized global electrophysiological mapping of the atrium in patients with Wolff-Parkinson-White syndrome. Ann Thorac Surg. 1988 Aug;46(2):223–231. doi: 10.1016/s0003-4975(10)65903-6. [DOI] [PubMed] [Google Scholar]
  3. Canavan T. E., Schuessler R. B., Cain M. E., Lindsay B. D., Boineau J. P., Corr P. B., Cox J. L. Computerized global electrophysiological mapping of the atrium in a patient with multiple supraventricular tachyarrhythmias. Ann Thorac Surg. 1988 Aug;46(2):232–235. doi: 10.1016/s0003-4975(10)65904-8. [DOI] [PubMed] [Google Scholar]
  4. Cobler J. L., Williams M. E., Greenland P. Thyrotoxicosis in institutionalized elderly patients with atrial fibrillation. Arch Intern Med. 1984 Sep;144(9):1758–1760. [PubMed] [Google Scholar]
  5. Cox J. L., Boineau J. P., Schuessler R. B., Ferguson T. B., Jr, Cain M. E., Lindsay B. D., Corr P. B., Kater K. M., Lappas D. G. Successful surgical treatment of atrial fibrillation. Review and clinical update. JAMA. 1991 Oct 9;266(14):1976–1980. [PubMed] [Google Scholar]
  6. Cox J. L., Boineau J. P., Schuessler R. B., Jaquiss R. D., Lappas D. G. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg. 1995 Aug;110(2):473–484. doi: 10.1016/S0022-5223(95)70244-X. [DOI] [PubMed] [Google Scholar]
  7. Cox J. L., Boineau J. P., Schuessler R. B., Kater K. M., Ferguson T. B., Jr, Cain M. E., Lindsay B. D., Smith J. M., Corr P. B., Hogue C. B. Electrophysiologic basis, surgical development, and clinical results of the maze procedure for atrial flutter and atrial fibrillation. Adv Card Surg. 1995;6:1–67. [PubMed] [Google Scholar]
  8. Cox J. L., Boineau J. P., Schuessler R. B., Kater K. M., Lappas D. G. Five-year experience with the maze procedure for atrial fibrillation. Ann Thorac Surg. 1993 Oct;56(4):814–824. doi: 10.1016/0003-4975(93)90338-i. [DOI] [PubMed] [Google Scholar]
  9. Cox J. L., Canavan T. E., Schuessler R. B., Cain M. E., Lindsay B. D., Stone C., Smith P. K., Corr P. B., Boineau J. P. The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg. 1991 Mar;101(3):406–426. [PubMed] [Google Scholar]
  10. Cox J. L. Evolving applications of the maze procedure for atrial fibrillation. Ann Thorac Surg. 1993 Mar;55(3):578–580. doi: 10.1016/0003-4975(93)90251-c. [DOI] [PubMed] [Google Scholar]
  11. Cox J. L., Jaquiss R. D., Schuessler R. B., Boineau J. P. Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. J Thorac Cardiovasc Surg. 1995 Aug;110(2):485–495. doi: 10.1016/S0022-5223(95)70245-8. [DOI] [PubMed] [Google Scholar]
  12. Cox J. L., Schuessler R. B., Boineau J. P. The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg. 1991 Mar;101(3):402–405. [PubMed] [Google Scholar]
  13. Cox J. L., Schuessler R. B., D'Agostino H. J., Jr, Stone C. M., Chang B. C., Cain M. E., Corr P. B., Boineau J. P. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg. 1991 Apr;101(4):569–583. [PubMed] [Google Scholar]
  14. Cox J. L. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg. 1991 Apr;101(4):584–592. [PubMed] [Google Scholar]
  15. Diamantopoulos E. J., Anthopoulos L., Nanas S., Maliaras G., Chrisos D., Moulopoulos S. D. Detection of arrhythmias in a representative sample of the Athens population. Eur Heart J. 1987 Aug;8 (Suppl 500):17–19. doi: 10.1093/eurheartj/8.suppl_d.17. [DOI] [PubMed] [Google Scholar]
  16. Hirosawa K., Sekiguchi M., Kasanuki H., Kimata S., Kaneko N., Nakamura K., Aosaki M., Takahashi S., Kondo M. Natural history of atrial fibrillation. Heart Vessels Suppl. 1987;2:14–23. [PubMed] [Google Scholar]
  17. Martin A., Benbow L. J., Butrous G. S., Leach C., Camm A. J. Five-year follow-up of 101 elderly subjects by means of long-term ambulatory cardiac monitoring. Eur Heart J. 1984 Jul;5(7):592–596. doi: 10.1093/oxfordjournals.eurheartj.a061710. [DOI] [PubMed] [Google Scholar]
  18. Onundarson P. T., Thorgeirsson G., Jonmundsson E., Sigfusson N., Hardarson T. Chronic atrial fibrillation--epidemiologic features and 14 year follow-up: a case control study. Eur Heart J. 1987 May;8(5):521–527. doi: 10.1093/oxfordjournals.eurheartj.a062312. [DOI] [PubMed] [Google Scholar]
  19. Petersen P., Boysen G., Godtfredsen J., Andersen E. D., Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989 Jan 28;1(8631):175–179. doi: 10.1016/s0140-6736(89)91200-2. [DOI] [PubMed] [Google Scholar]
  20. Savage D. D., Garrison R. J., Castelli W. P., McNamara P. M., Anderson S. J., Kannel W. B., Feinleib M. Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study). Am J Cardiol. 1983 May 1;51(8):1375–1378. doi: 10.1016/0002-9149(83)90315-6. [DOI] [PubMed] [Google Scholar]
  21. Scheinman M. M., Morady F., Hess D. S., Gonzalez R. Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA. 1982 Aug 20;248(7):851–855. [PubMed] [Google Scholar]
  22. Treseder A. S., Sastry B. S., Thomas T. P., Yates M. A., Pathy M. S. Atrial fibrillation and stroke in elderly hospitalized patients. Age Ageing. 1986 Mar;15(2):89–92. doi: 10.1093/ageing/15.2.89. [DOI] [PubMed] [Google Scholar]
  23. Tàmmaro A. E., Ronzoni D., Bonaccorso O., Buttè M., Carella G. R., Colombo A. M., Cottino M., Frustaglia A., Gemmellaro P., Picceo M. T. Le aritmie nell'anziano. Minerva Med. 1983 May 19;74(21):1313–1318. [PubMed] [Google Scholar]
  24. Williams J. M., Ungerleider R. M., Lofland G. K., Cox J. L. Left atrial isolation: new technique for the treatment of supraventricular arrhythmias. J Thorac Cardiovasc Surg. 1980 Sep;80(3):373–380. [PubMed] [Google Scholar]

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