Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery

Background. Success of the maze procedure after mitral operations with large left atria and permanent atrial fibrillation remains suboptimal. Current technique variations tend to obscure the decision-making algorithm in these patients. A single energy-source approach for the surgical management of patients with large left atria and permanent atrial fibrillation is presented. Methods. From January 2003 to July 2005, 71 consecutive drug-resistant patients with permanent atrial fibrillation and left atrial enlargement who required mitral valve surgery underwent aggressive left atrial reduction combined with left-sided only irrigated radiofrequency unipolar maze. Left atrial dimensions were measured by transesophageal echo anterior-to-posterior leading edge-to-edge standardized protocol. There were 39 men (54.9%) and 32 women (45.1%), and their mean age was 71.9 +/- 9.5 years. Mean duration of atrial fibrillation was 49.3 +/- 58.0 months. Results. All patients underwent left atrial reduction with identical Cox-maze III pulmonary vein and appendage isolation including mitral annular connection, followed by appendage suture closure. Left atrial size was reduced from 6.7 +/- 1.2 cm to 4.3 +/- 0.6 cm (p = 0.001). Mitral valve repair was performed in 55 patients (76.1%) and replacement in 17 (23.9%). The 30-day mortality was 4.2% (3/71). Postoperative length of stay was 8.8 +/- 5.7 days, with 56 (82.4%) of 68 patients discharged in normal sinus rhythm. P-wave sinus rhythm was 93.8% between 7 and 12 months and 92.0% for patients with 1 year or more of follow-up. Conclusions. Left atrial reduction combined with a left atrial only single energy-source radiofrequency maze procedure is an effective treatment for patients with permanent atrial fibrillation undergoing concomitant mitral operations.