Copyright © 2002 by the European Society of Cardiology.
Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial
a Department of Cardiology, University Hospital Bergmannsheil, Bochum, Germany
b Clinic for Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
c Institute of Pathology, University Hospital Bergmannsheil, Bochum, Germany
revised June 15, 2001; accepted June 27, 2001
Abstract
Aims This study is the first prospective randomized trial evaluating the efficacy of an antiarrhythmic surgical procedure in patients with chronic atrial fibrillation undergoing mitral valve replacement.
Methods and Results Thirty consecutive patients with chronic atrial fibrillation undergoing mitral valve replacement were randomized for an additional modified MAZE-operation using intra-operatively cooled-tip radiofrequency ablation (group A) or mitral valve replacement alone (group B). Biatrial contraction was studied and functional capacity was evaluated in spiro-ergometry 6 months after surgery. Thirty-day mortality was 0% in both groups. After 12 months, sinus rhythm was reinstituted significantly more often in patients of group A (cumulative rate of sinus rhythm 0·800) compared to patients in group B (0·267) (P<0·01). 66·7% of patients in sinus rhythm of group A had documented biatrial contraction. Electrocardioversion showed long-term success in only 17% of patients in group A and 0% in group B. Maximal aerobic uptake at the 6-month spiro-ergometry revealed no significant difference (9·3 vs 8·5ml.min–1 kg–1, P=0·530).
Conclusions A modified MAZE operation using cooled-tip radiofrequency ablation can be safely combined with mitral valve surgery and is highly effective in restoring sinus rhythm. Biatrial contraction is found in 66·7% of patients with sinus rhythm undergoing mitral valve replacement plus the MAZE operation.
Key Words: MAZE surgery, cooled-tip radiofrequency ablation, sinus rhythm, atrial fibrillation, biatrial contraction, functional results
f1 Correspondence: Thomas Deneke, Department of Cardiology, Bergmannsheil Bochum, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
References
- Ostrander LD Jr, Brandt RL, Kjeldsberg MO. Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation. 1965;31:888–898
[Abstract/Free Full Text] - Kannel WB, Abbott RD, Savage DD. Epidemiologic features of chronic atrial fibrillation: The Framingham study. N Engl J Med. 1982;307:1018–1022
- Melo JQ, Neves J, Adragão P. When and how to report results of surgery on atrial fibrillation. Eur J Cardiothorac Surg. 1997;12:739–744[Abstract]
- Cox JL, Schuessler RB, Agostino HJ. The surgical treatment of atrial fibrillation. J Thorac Cardiovasc Surg. 1991;101:569–583[Abstract]
- Cox JL, Boineau JP, Schuessler RB. Operations for atrial fibrillation. Clin Cardiol. 1991;14:827–834[ISI][Medline]
- Cox JL, Boineau JP, Schuessler RB. Successful surgical treatment of atrial fibrillation. Review and clinical update. JAMA. 1991;266:1976–1980[Abstract]
- Izumoto H, Kawazoe K, Eishi K, Kamata J. Medium-term results after modified Cox/Maze procedure combined with other cardiac surgery. Eur J Cardio Surg. 2000;17:25–29
- Jais P, Haissaguerre M, Shah DC. A Focal Source of Atrial Fibrillation Treated by Discrete Radiofrequency Ablation. Circulation. 1997;95:572–576
[Abstract/Free Full Text] - Leich J, Klein G, Yee R, Guiraudon G. Sinus node-atrioventricular node isolation: Long-term results with the corridor operation for atrial fibrillation. J Am Coll Cardiol. 1991;17:970–975[Abstract]
- Moe GK. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther. 1962;140:183–188[ISI]
- Izumoto H, Kawazone K, Kitahara H, Kamata J. Operative results after the Cox/maze procedure combined with a mitral valve operation. Ann Thorac Surg. 1998;66:800–804
[Abstract/Free Full Text] - Isobe F, Kawashima Y. The outcome and indications of the Cox maze III procedure for chronic atrial fibrillation with mitral valve disease. J Thorac Cardiovasc Surg. 1998;116:220–227
[Abstract/Free Full Text] - Lönnerholm S, Blomström P, Nilsson L, Oxelbark S, Jideus L, Blomström-Lundqvist C. Effects of the Maze Operation on health-related quality of life in patients with atrial fibrillation. Circulation. 2000;101:2607–2611
[Abstract/Free Full Text] - Beukema WP, Sie H, Misier A, Haalebos M, Schipper C. Radiofrequency ablation of atrial fibrillation in patients undergoing concomitant cardiac surgery. First experience (Abstr). PACE. 1997;20:
- Lemke B, Khargi K, Deneke T. A prospective randomized trial to evaluate the effectiveness of the Cox-MAZE-III-Operation using cooled tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease (Abstr). PACE. 2000;303:
- Kosakai Y, Kawaguchi AT, Isobe F. Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg. 1994;108:1049–1055
[Abstract/Free Full Text] - Melo J, Adragão P, Neves J. Surgery of atrial fibrillation using radiofrequency catheter ablation: Assessment of results at one year. Eur J Cardiothorac Surg. 1999;15:851–855
[Abstract/Free Full Text] - Kim YJ, Sohn DW, Park DG. Restoration of atrial mechanical function after maze operation in patients with structural heart disease. Am Heart J. 1998;136:1070–1074[CrossRef][ISI][Medline]
- Cox JL, Schuessler RB, Lappas DG, Boineau JP. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg. 1996;224:167–173
- Cox JL, Boineau JP, Schuessler RB, Jaquiss RDB, Lappas DG. Modification of the maze procedure for atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg. 1995;110:473–484
[Abstract/Free Full Text] - Handa N, Schaff HV, Morris JJ. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac and Cardiovasc Surg. 1999;118:628–635
[Abstract/Free Full Text] - Sueda T, Nagata H, Orihashi K. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg. 1997;63:1070–1075
[Abstract/Free Full Text] - Kawaguchi AT, Kosakai Y, Sasako Y, Eishi K, Nakano K, Kawashima Y. Risks and benefits of combined maze procedure for atrial fibrillation associated with organic heart disease. J Am Coll Cardiol. 1996;28:985–990[Abstract]
- Kamata J, Kawazoe K, Izumoto H. Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. Ann Thorac Surg. 1997;64:394–398
[Abstract/Free Full Text] - Weber KT, Janicki JS, McElroy PA. Cardiopulmonary exercise testing. Weber KT, Janicki JS. Cardiopulmonary Exercise Testing. Philadelphia: W. B. Saunders Co; 1986. p. 153
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Chaiyaroj, T. Ngarmukos, and P. Lertsithichai Predictors of Sinus Rhythm after Radiofrequency Maze and Mitral Valve Surgery Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Ghavidel, H. Javadpour, M. Shafiee, M.-B. Tabatabaie, K. Raiesi, and S. Hosseini Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1043 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Voeller, R. B. Schuessler, and R. J. Damiano Jr. Surgical Treatment of Atrial Fibrillation Card. Surg. Adult, January 1, 2008; 3(2008): 1375 - 1394. [Full Text]
|
|
|
|
 |
|
 C. Blomstrom-Lundqvist, B. Johansson, E. Berglin, L. Nilsson, S. M. Jensen, S. Thelin, A. Holmgren, N. Edvardsson, G. Kallner, and P. Blomstrom A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF) Eur. Heart J., December 1, 2007; 28(23): 2902 - 2908. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W.W. Wong and K.-H. Mak Impact of Maze and Concomitant Mitral Valve Surgery on Clinical Outcomes Ann. Thorac. Surg., November 1, 2006; 82(5): 1938 - 1947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Knaut, S. M. Tugtekin, S. G. Spitzer, F. Jung, and K. Matschke Intraoperative endocardial microwave ablation for treatment of permanent atrial fibrillation during coronary artery bypass surgery: 1-year follow-up. Europace, January 1, 2006; 8(1): 16 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Doukas, N. J. Samani, C. Alexiou, M. Oc, D. T. Chin, P. G. Stafford, L. L. Ng, and T. J. Spyt Left Atrial Radiofrequency Ablation During Mitral Valve Surgery for Continuous Atrial Fibrillation: A Randomized Controlled Trial JAMA, November 9, 2005; 294(18): 2323 - 2329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Reston and J. H. Shuhaiber Meta-analysis of clinical outcomes of maze-related surgical procedures for medically refractory atrial fibrillation Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 724 - 730. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Deneke, K. Khargi, K.-M. Muller, B. Lemke, A. Mugge, A. Laczkovics, A. E. Becker, and P. H. Grewe Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation Eur. Heart J., September 1, 2005; 26(17): 1797 - 1803. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A.C. Abreu Filho, L. A.F. Lisboa, L. A.O. Dallan, G. S. Spina, M. Grinberg, M. Scanavacca, E. A. Sosa, J. A. F. Ramires, and S. A. Oliveira Effectiveness of the Maze Procedure Using Cooled-Tip Radiofrequency Ablation in Patients With Permanent Atrial Fibrillation and Rheumatic Mitral Valve Disease Circulation, August 30, 2005; 112(9_suppl): I-20 - I-25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Khargi, B. Lemke, and T. Deneke Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation in CABG and AVR patients are as effective as in mitral valve patients Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. O'Donnell, G. Agnelli, and J. I. Weitz Emerging therapies for stroke prevention in atrial fibrillation Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C19 - C27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ruel, F. D. Rubens, R. G. Masters, A. L. Pipe, P. Bedard, and T. G. Mesana Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 278 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wisser, C. Khazen, E. Deviatko, G. Stix, T. Binder, R. Seitelberger, H. Schmidinger, and E. Wolner Microwave and radiofrequency ablation yield similar success rates for treatment of chronic atrial fibrillation Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 1011 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Khargi, B. Lemke, H. Haardt, K.-M. Muller, A. Mugge, A. Laczkovics, and T. Deneke Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients: expansion of the indication? Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 1018 - 1024. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Pachon M, E. I. Pachon M, J. C. Pachon M, T. J. Lobo, M. Z. Pachon, R. N. A. Vargas, D. Q. V. Pachon, F. J. Lopez M, and A. D. Jatene A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation Europace, January 1, 2004; 6(6): 590 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Yuda, S Nakatani, Y Kosakai, T Satoh, Y Goto, M Yamagishi, K Bando, S Kitamura, and K Miyatake Mechanism of improvement in exercise capacity after the maze procedure combined with mitral valve surgery Heart, January 1, 2004; 90(1): 64 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Khargi, T. Deneke, B. Lemke, and A. Laczkovics Irrigated radiofrequency ablation is a safe and effective technique to treat chronic atrial fibrillation Interactive CardioVascular and Thoracic Surgery, September 1, 2003; 2(3): 241 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pappone Atrial fibrillation--a curable condition? Eur. Heart J., April 1, 2002; 23(7): 514 - 517. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||