Clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Nan , JIANG Zhaolei ,  MEI Ju , LU Rongxin , TANG Min , DING Fangbao

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: meiju@xinhuamed.com.cn

Keywords：

Atrial fibrillation; thoracoscopy; ablation; left ventricular dysfunction

DOI：

10.7507/1007-4848.201904011

Video：

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Objective To study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.Methods From June 2010 to December 2017, 86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females, with an average age of 60.7±5.9 years. Among them, 12 were with paroxysmal, 27 were with persistent and 47 were with long-standing persistent atrial fibrillation. The mean atrial fibrillation duration was 6.5±4.8 years. CHA2DS2-VASc score was 2.2±1.1. The mean diameter of left atrium was 46.9±3.8 mm. The mean diameter of left ventricle was 51.7±4.6 mm. The preoperative ejection fraction was 42.2%±4.7%. All patients received Mini Maze procedure after general anesthesia. The ablation included 3 annular ablations and 3 linear ablations. The left atrial appendage was excised by Endo-Gia. Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.Results Eighty-six patients successfully completed the procedure without transition to thoracotomy. There was no death during the perioperative period. Seventy-seven patients (89.5%) maintained sinus rhythm at discharge. Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm. The overall postoperative left ventricular ejection fraction was 47.1%±6.2%. The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%, and the ejection fraction of the non-sinus group was 41.6%±5.8% (P<0.05). Multivariate regression analysis showed a left atrial diameter (HR=1.485, 95%CI 1.157-1.906, P<0.05) and an increase in ejection fraction over 10% (HR=18.800, 95%CI 1.674-189.289, P<0.05) were closely related to postoperative recurrence. Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10% (P<0.05).Conclusion Mini Maze procedure is safe and effective in the treatment of atrial fibrillation patients with left ventricular systolic dysfunction, which helps to improve left ventricular function to prevent the vicious circle of atrial fibrillation and heart failure.

Citation： MA Nan, JIANG Zhaolei, MEI Ju, LU Rongxin, TANG Min, DING Fangbao. Clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 68-72. doi: 10.7507/1007-4848.201904011 Copy

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2.	Di Biase L, Mohanty P, Mohanty S, et al. Ablation vs. amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: Results from the AATAC multicenter randomized trial. Circulation, 2016, 133(17): 1637-44.
3.	Vítovec J, Špinar J, Špinarová L. Arrhythmias and conductance disturbances and heart failure. VnitrLek, 2018, 64(9): 874-877.
4.	Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol, 2004, 43(6): 1004-1009.
5.	Nedios S, Sommer P, Dagres N, et al. Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control. Heart Rhythm, 2014, 11(3): 344-351.
6.	Khan MN, Jaïs P, Cummings J, et al. PABA-CHF investigators: pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med, 2008, 359(17): 1778-1785.
7.	马南, 姜兆磊, 陈飞, 等. 梅氏微创消融术治疗心房颤动 207 例. 中国胸心血管外科临床杂志, 2015, 22(11): 996-999.
8.	Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
9.	马南, 梅举, 卢荣鑫, 等. 梅式微创消融术治疗导管消融失败心房颤动者的临床结果. 中华心血管病杂志, 2018, 46(8): 601-605.
10.	李建美, 郑甲林, 陶四明, 等. 导管消融持续性房颤合并心力衰竭患者的治疗进展. 医学综述, 2011, 17(24): 3750-3753.
11.	Anselmino M, Grossi S, Scaglione M, et al. Long-term results of transcatheter atrial fibrillation ablation in patients with impaired left ventricular systolic function. J Cardiovasc Electrophysiol, 2013, 24(1): 24-32.
12.	Rillig A, Makimoto H, Wegner J, et al. Six-year clinical outcomes after catheter ablation of atrial fibrillation in patients with impaired left ventricular function. J Cardiovasc Electrophysiol, 2015, 26(11): 1169-1179.
13.	Jarman JWE, Hussain W, Wong T, et al. Resource use and clinical outcomes in patients with atrial fibrillation with ablation versus antiarrhythmic drug treatment. BMC Cardiovasc Disord, 2018, 18(1): 211.
14.	Pappone C, Radinovic A, Manguso F, et al. Atrial fibrillation progression and management: a 5-year prospective follow-up study. Heart Rhythm, 2008, 5(11): 1501-1507.
15.	Schreiber D, Rostock T, Fröhlich M, et al. Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circ Arrhythm Electrophysiol, 2015, 8(2): 308-317.
16.	Ma N, Zhao D, Zhao N, et al. Study on left atrial dimension and function after modified endoscopic procedure for atrial fibrillation at two years' follow-up. Ann Thorac Surg, 2016, 101(5): 1724-1728.
17.	Jones DG, Haldar SK, Hussain W, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol, 2013, 61(18): 1894-1903.
18.	Hunter RJ, Berriman TJ, Diab I, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol, 2014, 7(1): 31-38.
19.	Santangeli P, Marchlinski FE. Techniques for the provocation, localization, and ablation of non-pulmonary vein triggers for atrial fibrillation. Heart Rhythm, 2017, S1547-5271(17): 30289-30298.
20.	Zembala M, Filipiak K, Kowalski O, et al. Staged hybrid ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long-term observation. Arch Med Sci, 2017, 13(1): 109-117.

1. 胡大一, 孙艺红. 心房颤动的流行病学和治疗现状. 中华全科医师杂志, 2006, 5(1): 5-7.
2. Di Biase L, Mohanty P, Mohanty S, et al. Ablation vs. amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: Results from the AATAC multicenter randomized trial. Circulation, 2016, 133(17): 1637-44.
3. Vítovec J, Špinar J, Špinarová L. Arrhythmias and conductance disturbances and heart failure. VnitrLek, 2018, 64(9): 874-877.
4. Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol, 2004, 43(6): 1004-1009.
5. Nedios S, Sommer P, Dagres N, et al. Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control. Heart Rhythm, 2014, 11(3): 344-351.
6. Khan MN, Jaïs P, Cummings J, et al. PABA-CHF investigators: pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med, 2008, 359(17): 1778-1785.
7. 马南, 姜兆磊, 陈飞, 等. 梅氏微创消融术治疗心房颤动 207 例. 中国胸心血管外科临床杂志, 2015, 22(11): 996-999.
8. Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
9. 马南, 梅举, 卢荣鑫, 等. 梅式微创消融术治疗导管消融失败心房颤动者的临床结果. 中华心血管病杂志, 2018, 46(8): 601-605.
10. 李建美, 郑甲林, 陶四明, 等. 导管消融持续性房颤合并心力衰竭患者的治疗进展. 医学综述, 2011, 17(24): 3750-3753.
11. Anselmino M, Grossi S, Scaglione M, et al. Long-term results of transcatheter atrial fibrillation ablation in patients with impaired left ventricular systolic function. J Cardiovasc Electrophysiol, 2013, 24(1): 24-32.
12. Rillig A, Makimoto H, Wegner J, et al. Six-year clinical outcomes after catheter ablation of atrial fibrillation in patients with impaired left ventricular function. J Cardiovasc Electrophysiol, 2015, 26(11): 1169-1179.
13. Jarman JWE, Hussain W, Wong T, et al. Resource use and clinical outcomes in patients with atrial fibrillation with ablation versus antiarrhythmic drug treatment. BMC Cardiovasc Disord, 2018, 18(1): 211.
14. Pappone C, Radinovic A, Manguso F, et al. Atrial fibrillation progression and management: a 5-year prospective follow-up study. Heart Rhythm, 2008, 5(11): 1501-1507.
15. Schreiber D, Rostock T, Fröhlich M, et al. Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circ Arrhythm Electrophysiol, 2015, 8(2): 308-317.
16. Ma N, Zhao D, Zhao N, et al. Study on left atrial dimension and function after modified endoscopic procedure for atrial fibrillation at two years' follow-up. Ann Thorac Surg, 2016, 101(5): 1724-1728.
17. Jones DG, Haldar SK, Hussain W, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol, 2013, 61(18): 1894-1903.
18. Hunter RJ, Berriman TJ, Diab I, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol, 2014, 7(1): 31-38.
19. Santangeli P, Marchlinski FE. Techniques for the provocation, localization, and ablation of non-pulmonary vein triggers for atrial fibrillation. Heart Rhythm, 2017, S1547-5271(17): 30289-30298.
20. Zembala M, Filipiak K, Kowalski O, et al. Staged hybrid ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long-term observation. Arch Med Sci, 2017, 13(1): 109-117.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function

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