The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium

Abstract

Objective: The presence of a giant left atrium (LA) is strongly associated with the recurrence of atrial fibrillation (AF) after the maze procedure. Therefore, we investigated the factors affecting the rhythm outcomes after the maze procedure in patients with a giant LA and AF-associated mitral valve disease to determine the best candidates for the maze procedure in this population.

Methods: From January 1999 to December 2006, 224 patients with a giant LA (> 60 mm) underwent bi-atrial maze procedures combined with mitral valve surgery. Multivariate Cox regression analysis was performed to determine the risk factors for maze failure.

Results: Follow-up was complete in all patients at a mean of 48.3 ± 28.0 months, during which 4 early and 9 late deaths occurred. Of the 218 early survivors, 24 had late AF recurrence. The 5-year AF-free rate was 87.1% ± 4.3% in patients 50 years or younger and 77.3% ± 4.1% in patients older than 50 years (P = .001). Univariate analysis showed that advanced patient age (> 50 years), a longer duration of AF, a fine AF pattern (wave length < 1 mm), and increased cardiothoracic ratio (> 60%) were associated with late AF recurrence. On multivariate analysis, advanced patient age was the only significant, independent risk factor for AF recurrence.

Conclusions: Although giant LA is known to be a predictor of poor outcomes after the maze procedure, younger patients had more favorable rhythm outcomes than older patients, as shown by the superior freedom from AF recurrence. A more aggressive surgical approach in younger patients might eliminate AF, even in the presence of a giant LA.