Abstract 17466: Predictor of Long-term Atrial Fibrillation Recurrence Post Hybrid-MAZE Procedure: Five-Year Outcomes
Introduction: Minimally invasive surgical (MIS) MAZE has an important role in the treatment of atrial fibrillation (AF). Intra-operative EP techniques during the MIS MAZE surgery enhance lesion efficacy, and are associated with acceptable safety and short-term success as previously described. This case series demonstrates persistent success rates at five year follow up from novel hybrid MIS MAZE.
Methods: 32 consecutive patients (mean age 68, mean left atrial size 6.6 cm) with symptomatic long-standing persistent AF underwent MIS MAZE with intraoperative electrophysiologic evaluation of acute lesion efficacy. Surgical pulmonary vein isolation and bi-atrial extended lesion sets were performed using the Aticure® system. Electrogram recording was performed by closely spaced electrode catheter placed epicardially by the surgeon at regions of interest as directed by the electrophysiologist. Post-ablation EP study and assessment of conduction block with differential pacing and arrhythmia induction were performed. Follow up was performed according to Heart Rhythm Society guidelines and then bi-annually after first year.
Results: More than 84% of patients were able to maintain normal sinus rhythm at 1-year follow-up. At 5-year follow-up, 6 patients were lost to follow-up after 2 years, and 2 deaths unrelated to atrial fibrillation. Only 6 of 24 (18%) patients maintained normal sinus rhythm at five year. Of the 18 AF recurrences, LA size was 6.3cm. 16 of 18 patients have hypertension, 14 of 18 patients have diabetes, 12 of 18 have Class III congestive heart failure with an average EF of 38%, and 8 of 18 has obstructive sleep apnea. Of the 6 patients free from AF after 5 years, there was no congestive heart failure, sleep apnea, 2 of 6 has hypertension and 1 of 6 has diabetes.
Conclusions: Extensive bi-atrial modification with hybrid MIS MAZE has improved short-term success rates when compared to ablation or surgical procedures alone with maintenance of normal sinus rhythm for the initial year. However, long-term freedom from atrial fibrillation is limited at 5 years. Avoidance and control of potential exacerbating factors may improve long-term outcome.
Author Disclosures: A. Chiu: None. M. Al-Zubaidi: None. K. Fang: None. W. Su: None.
- © 2014 by American Heart Association, Inc.