RESUMO
BACKGROUND: From August 1993 to May 1994, 20 patients (mean age, 43 years) with atrial fibrillation underwent the maze operation without cryoablation. Ten patients had mitral stenosis, 5 had mitral insufficiency, and 5 had a mixed mitral lesion. The mean left atrial diameter as measured on echocardiograms was 6.1 cm. The cause was rheumatic in 17 patients (85%) and degenerative in 3 (15%). Seven patients had had previous episodes of thromboembolism. METHODS: Mitral valvuloplasty was performed on 7 patients, mitral commissurotomy on 4, and mitral valve replacement on 9. Thrombi were found in the left atrium of 7 patients and also in the right atrium in 2. The mean cross-clamp time was 73 minutes (range, 52 to 108 minutes). RESULTS: Patients were discharged from the hospital in good condition. Hemodynamic studies and Doppler echocardiograms showed significant reduction in the left atrial diameter (mean diameter, 4.9 cm; p < 0.01) in 18 patients. The two-channel Holter monitor showed sinus rhythm in 15 patients, atrial ectopic rhythm in 4, and atrial fibrillation in 1. Eleven patients (55%) experienced atrial fibrillation (9 in the first 3 months postoperatively), which was reversed with quinidine. Ninety percent of patients had development of an effective, synchronous, atrial systole. Six to 15 months postoperatively (average follow-up, 10 months), all patients were in functional class I, and 18 were not on a regimen of antiarrhythmic medication. CONCLUSIONS: This simplification of the maze operation has been demonstrated to be an effective alternative for the treatment of chronic atrial fibrillation.
