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(Circulation. 2004;110:II-164 – II-168.)
© 2004 American Heart Association, Inc.

Arrythmia Surgery

Atrial Tachyarrhythmias After the Maze Procedure

Incidence and Prognosis

Yosuke Ishii, MD; Marye J. Gleva, MD; M. Carolyn Gamache, MD; Richard B. Schuessler, PhD; John P. Boineau, MD; Marci S. Bailey, RN; Ralph J. Damiano, Jr, MD

From Washington University School of Medicine, Division of Cardiothoracic Surgery (Y.I., R.B.S., J.P.B., M.S.B., R.J.D.), St. Louis, Mo; Washington University School of Medicine, Division of Cardiology (M.J.G.), St. Louis, Mo; Metro Heart Group (C.G.), St. Louis, Mo.

Correspondence to Ralph J. Damiano, Jr, MD, Suite 3108, Queeny Tower, Barnes–Jewish Hospital Plaza, St. Louis, MO 63110. E-mail damianor{at}wustl.edu

Background— The Maze procedure restores normal sinus rhythm in the majority of patients. However, atrial tachyarrhythmias (ATA) are a common early complication after the operation. The purpose of this study was to define the incidence and natural history of ATA after the Maze procedure.

Methods— Complete medical records from 200 patients who underwent the Maze procedures (I, II, and III) from 1987 to 2002 were examined for all episodes of early postoperative ATA that occurred during the first 30 days after the procedure. Two electrophysiologists independently reviewed all postoperative 12-lead electrocardiograms.

Results— ATA occurred in 86 patients (43%) after the Maze procedure. Of the patients with ATA, 59% had atrial fibrillation (AF), 14% had atrial flutter (AFL), and 27% had both AF and AFL. Of the patients with AF or AFL, 20% and 5%, respectively, also had episodes of atrial tachycardia and supraventricular tachyarrhythmia. The peak incidence of early postoperative ATA was on postoperative day 8. The average duration of ATA was 5.7±5.0 days. Late recurrence of AF (>1 year postoperatively) occurred in 7.0% of patients who had early postoperative ATA and 8.8% of patients without early postoperative ATA (P=0.8).

Conclusions— ATA occurred in 43% of patients after the Maze procedure. The tachyarrhythmias occurred primarily within 8 days after surgery and resolved within 3 weeks in almost all patients. There was no relationship between the incidence of early postoperative ATA and the late recurrence of AF.

Key Words: arrhythmia • fibrillation • surgery • tachyarrhythmias