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Randomized Controlled Trial
. 2014 Sep-Oct;66(5):510-6.
doi: 10.1016/j.ihj.2014.05.010. Epub 2014 Jun 6.

Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery

Sajid A Sayed  1 , Ashish Katewa  2 , Vivek Srivastava  2 , Sujit Jana  3 , Anil M Patwardhan  4
Affiliations
Randomized Controlled Trial

Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery

Sajid A Sayed et al. Indian Heart J. 2014 Sep-Oct.

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).

Discussion: 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.

Keywords: AF; Arrhythmia therapy (radial approach, Maze); Rheumatic disease.

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Figures

Fig. 1
Fig. 1
Modified radiofrequency biatrial maze. IVC: inferior vena cava; LAA: left atrial appendage; MV: mitral valve; PV: pulmonary vein; RAA: right atrial appendage; SAN: sinoatrial node; SVC: superior vena cava; TV: tricuspid valve.
Fig. 2
Fig. 2
Modified radiofrequency radial procedure. IVC: inferior vena cava; LAA: left atrial appendage; MV: mitral valve; PV: pulmonary vein; RAA: right atrial appendage; SAN: sinoatrial node; SVC: superior vena cava; TV: tricuspid valve.
Fig. 3
Fig. 3
Post-procedure protocol. AF: atrial fibrillation; NSR: normal sinus rhythm; RF: radiofrequency.
See this image and copyright information in PMC

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