Abstract 14718: Rheumatic Disease and Atrial Fibrillation Duration Are Predictors of Inability to Recover Atrial Contractility After MAZE IV Surgery.
Introduction: MAZE IV surgery is an effective option to restore sinus rhythm (SR) and atrial contraction (AC) in patients with no rheumatic persistent atrial fibrillation (AF). However, there is less information on the effectiveness to restore AC in patients with rheumatic disease.
Hypothesis: To assess the effectiveness of the MAZE IV surgery on restoring AC in patients with rheumatic disease and long lasting persistent AF.
Methods: Prospective, consecutive study in patients underwent cardiovascular surgery and had persistent AF in whom MAZE IV surgery was performed. Clinical follow-up, 24-hour Holter, echocardiogram and mitral annulus tissue Doppler were done at 1, 3, 6 and 12 months post surgery. The presence of AC was assessed by lateral mitral annulus tissue Doppler. Chi square test and Fisher test were used to analyze data. Receiver operating characteristic (ROC) curves were used to define the cutoff point in continuous variables. Kaplan-Meier curve was obtained using SPSS−13.0 statistical analysis software.
Results: A total of 107 patients were included. Mean age 64 years (+/− 12,4); 43 men (40%); 75 (70%) patients presented rheumatic disease. AF duration, 61months (+/−35,4). Primary indication for surgery: rheumatic mitral stenosis (65%%), aortic stenosis (6,5%), aortic insufficiency (4,5%), mitral insufficiency (22,5%) and coronary by pass surgery (4%). Mean left ventricular ejection fraction (LVEF) 49,5% (+/−12,6) and mean left atrial area 34 cm2 (+/−12,7). After a mean follow-up of 28 months (+/−9,3), 91 patients remained alive and 78 (86%) were in SR. AC was detected in 45 patients (58%). AC in rheumatic patients was absent in 62% vs 15% in non rheumatic; (p=0,002). When the duration of AF was < 5 years, 89% of patients in SR presented AC vs. AF duration > 5 years, 30% presented AC; p>0,001. The ROC curve for AF >5 years showed 85% sensibility and 93% specificity for the detection of patients who will not present AC (area under curve = 0,97).
Conclusions: In patients with rheumatic disease the absence of correlation between sinus rhythm and atrial contraction is significant. A history of AF lasting more than 5 years was a predictor for the absence of AC. This information may be useful in deciding long term anticoagulation after surgery.
- © 2010 by American Heart Association, Inc.