Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation / 中国胸心血管外科临床杂志

ABSTRACT

@#Objective    To analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF). Methods    In our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied. Results    All the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively. Conclusion    The recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.