Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Chao ^1,2 , WANG Huishan ² ,  HAN Jinsong ² , YIN Zongtao ² , ZHANG Xiling ²

1. Graduate School, General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, 110016, P.R.China;
2. Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Atrial fibrillation; valvular heart disease; Maze Ⅳ procedure; cryoablation; atrial contractility; treatment

DOI：

10.7507/1007-4848.202001011

Video：

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Objective To analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF).Methods In our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied.Results All the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively.Conclusion The recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.

Citation： MA Chao, WANG Huishan, HAN Jinsong, YIN Zongtao, ZHANG Xiling. Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1045-1054. doi: 10.7507/1007-4848.202001011 Copy

1.	Lip GYH, Collet JP, Caterina R, <italic>et al</italic>. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Thromb Haemost, 2017, 117(12): 2215-2236.
2.	Sepehri Shamloo A, Dagres N, Müssigbrodt A, <italic>et al</italic>. Atrial fibrillation and cognitive impairment: new insights and future directions. Heart Lung Circ, 2020, 29(1): 69-85.
3.	Esteves AF, Brito D, Rigueira J, <italic>et al</italic>. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
4.	Banerjee A, Allan V, Denaxas S, <italic>et al</italic>. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5.	Deneke T, Khargi K, Grewe PH, <italic>et al</italic>. Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J, 2002, 23(7): 558-566.
6.	Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
7.	Lombard FW, Liang Y. Risk factors for mitral valve surgery: atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
8.	Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1): 2-14.
9.	Ruaengsri C, Schill MR, Khiabani AJ, <italic>et al</italic>. The Cox-Maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
10.	Ad N, Holmes SD, Ali R, <italic>et al</italic>. A single center's experience with pacemaker implantation after the Cox Maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 154(1): 139-146.
11.	Cox JL, Ad N, Churyla A, <italic>et al</italic>. The Maze procedure and postoperative pacemakers. Ann Thorac Surg, 2018, 106(5): 1561-1569.
12.	Firmansyah DK, Soesanto AM, Hanafy DA, <italic>et al</italic>. Cox Maze Ⅳ versus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
13.	Nitta T, Ishii Y, Fujii M, <italic>et al</italic>. Restoration of sinus rhythm and atrial transport function after the Maze procedure: U lesion set versus box lesion set. J Thorac Cardiovasc Surg, 2016, 151(4): 1062-1069.
14.	Santhanakrishnan A, Okafor I, Kumar G, <italic>et al</italic>. Atrial systole enhances intraventricular filling flow propagation during increasing heart rate. J Biomech, 2016, 49(4): 618-623.
15.	Cox JL, Ad N, Palazzo T. Impact of the maze procedure on the stroke rate in patients with atrial fibrillation. J Thorac Cardiovasc Surg, 1999, 118(5): 833-840.
16.	Martínez-Comendador J, Gualis J, Marcos-Vidal JM, <italic>et al</italic>. Efficacy of oral anticoagulation in stroke prevention among sinus-rhythm patients who lack left atrial mechanical contraction after cryoablation. Tex Heart Inst J, 2015, 42(5): 430-437.
17.	Badhwar V, Rankin JS, Damiano RJ Jr, <italic>et al</italic>. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
18.	Baumgartner H, Falk V, Bax JJ, <italic>et al</italic>. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
19.	肖雄, 韩劲松, 王辉山, 等. 冷冻消融迷宫术治疗瓣膜病合并心房颤动的围术期管理. 中国体外循环杂志, 2018, 16(1): 29-32.
20.	Calkins H, Hindricks G, Cappato R, <italic>et al</italic>. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 2017, 14(10): e275-e444.
21.	Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
22.	Kim KM, Chung S, Kim SY, <italic>et al</italic>. Comparison of radiofrequency ablation and cryoablation for the recovery of atrial contractility and survival. Korean J Thorac Cardiovasc Surg, 2018, 51(4): 266-272.
23.	Cox JL. Intraoperative options for treating atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg, 2001, 122(2): 212-215.
24.	Cox JL, Churyla A, Malaisrie SC, <italic>et al</italic>. When is a Maze procedure a Maze procedure? Can J Cardiol, 2018, 34(11): 1482-1491.
25.	Abo-Salem E, Lockwood D, Boersma L, <italic>et al</italic>. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26: 1027-1037.
26.	Brennan AP, Martin W, Adams H, <italic>et al</italic>. Impact of the Cox-Maze Ⅳ procedure on left atrial mechanical function. Heart Lung Circ, 2019, 28(12): 1835-1840.
27.	Tinetti M, Costello R, Cardenas C, <italic>et al</italic>. Persistent atrial fibrillation is associated with inability to recover atrial contractility after MAZE Ⅳ surgery in rheumatic disease. Pacing Clin Electrophysiol, 2012, 35(8): 999-1004.
28.	Jeon CS, Shim MS, Park SJ, <italic>et al</italic>. The absence of atrial contraction as a predictor of permanent pacemaker implantation after Maze procedure with cryoablation. Korean J Thorac Cardiovasc Surg, 2017, 50(3): 163-170.
29.	Jeong DS, You JH, Jeon CS, <italic>et al</italic>. Impact of ablation duration on rhythm outcome after concomitant Maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30.	Ghavidel AA, Javadpour H, Shafiee M, <italic>et al</italic>. Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation. Eur J Cardiothorac Surg, 2008, 33(6): 1043-1048.
31.	Takasaki T, Sueda T, Imai K, <italic>et al</italic>. Mid-term results of the box pulmonary vein isolation and the cryo-Maze procedure for chronic atrial fibrillation associated with mitral valve disease. Gen Thorac Cardiovasc Surg, 2012, 60(2): 82-89.
32.	Albåge A, Péterffy M, Källner G. The biatrial cryo-Maze procedure for treatment of atrial fibrillation: a single-center experience. Scand Cardiovasc J, 2011, 45(2): 112-119.
33.	Vural Ü, Balcı AY, Ağlar AA, <italic>et al</italic>. Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation. Braz J Cardiovasc Surg, 2018, 33(6): 542-552.
34.	Lönnerholm S, Blomström P, Nilsson L, <italic>et al</italic>. Long-term effects of the Maze procedure on atrial size and mechanical function. Ann Thorac Surg, 2008, 85(3): 916-920.
35.	Wang M, Yip GW, Wang AY, <italic>et al</italic>. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol, 2003, 41(5): 820-826.
36.	Loardi C, Alamanni F, Galli C, <italic>et al</italic>. Surgical treatment of concomitant atrial fibrillation: focus onto atrial contractility. Biomed Res Int, 2015, 2015: 274817.
37.	Tsao HM, Hu WC, Tsai PH, <italic>et al</italic>. Functional remodeling of both atria is associated with occurrence of stroke in patients with paroxysmal and persistent atrial fibrillation. Acta Cardiol Sin, 2017, 33(1): 50-57.
38.	Kim HK, Kim YJ, Kim KI, <italic>et al</italic>. Impact of the Maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112(9 Suppl): I14-I19.
39.	Kim JB, Yun TJ, Chung CH, <italic>et al</italic>. Long-term outcome of modified Maze procedure combined with mitral valve surgery: analysis of outcomes according to type of mitral valve surgery. J Thorac Cardiovasc Surg, 2010, 139(1): 111-117.
40.	Gillinov AM, Sirak J, Blackstone EH, <italic>et al</italic>. The Cox Maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(6): 1653-1660.
41.	Kim HW, Moon MH, Jo KH, <italic>et al</italic>. Left atrial and left ventricular diastolic function after the Maze procedure for atrial fibrillation in mitral valve disease: degenerative versus rheumatic. Indian J Surg, 2015, 77(1): 7-15.
42.	Bauer EP, Szalay ZA, Brandt RR, <italic>et al</italic>. Predictors for atrial transport function after mini-Maze operation. Ann Thorac Surg, 2001, 72(4): 1251-1254.
43.	Kazui T, Henn MC, Watanabe Y, <italic>et al</italic>. The impact of 6 weeks of atrial fibrillation on left atrial and ventricular structure and function. J Thorac Cardiovasc Surg, 2015, 150(6): 1602-1608.
44.	Li Z, Wang Z, Yin Z, <italic>et al</italic>. Gender differences in fibrosis remodeling in patients with long-standing persistent atrial fibrillation. Oncotarget, 2017, 8(32): 53714-53729.
45.	Sunderland N, Maruthappu M, Nagendran M. What size of left atrium significantly impairs the success of maze surgery for atrial fibrillation? Interact Cardiovasc Thorac Surg, 2011, 13(3): 332-338.
46.	Gan GCH, Ferkh A, Boyd A, <italic>et al</italic>. Left atrial function: evaluation by strain analysis. Cardiovasc Diagn Ther, 2018, 8(1): 29-46.
47.	Curta A, Fichtner S, Wakili R, <italic>et al</italic>. Prospective evaluation of left atrial function and late gadolinium enhancement with 3 T MRI in patients with atrial fibrillation before and after catheter ablation. Int J Cardiovasc Imaging, 2019, 35(3): 499-504.

1. Lip GYH, Collet JP, Caterina R, <italic>et al</italic>. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Thromb Haemost, 2017, 117(12): 2215-2236.
2. Sepehri Shamloo A, Dagres N, Müssigbrodt A, <italic>et al</italic>. Atrial fibrillation and cognitive impairment: new insights and future directions. Heart Lung Circ, 2020, 29(1): 69-85.
3. Esteves AF, Brito D, Rigueira J, <italic>et al</italic>. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
4. Banerjee A, Allan V, Denaxas S, <italic>et al</italic>. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5. Deneke T, Khargi K, Grewe PH, <italic>et al</italic>. Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J, 2002, 23(7): 558-566.
6. Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
7. Lombard FW, Liang Y. Risk factors for mitral valve surgery: atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
8. Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1): 2-14.
9. Ruaengsri C, Schill MR, Khiabani AJ, <italic>et al</italic>. The Cox-Maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
10. Ad N, Holmes SD, Ali R, <italic>et al</italic>. A single center's experience with pacemaker implantation after the Cox Maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 154(1): 139-146.
11. Cox JL, Ad N, Churyla A, <italic>et al</italic>. The Maze procedure and postoperative pacemakers. Ann Thorac Surg, 2018, 106(5): 1561-1569.
12. Firmansyah DK, Soesanto AM, Hanafy DA, <italic>et al</italic>. Cox Maze Ⅳ versus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
13. Nitta T, Ishii Y, Fujii M, <italic>et al</italic>. Restoration of sinus rhythm and atrial transport function after the Maze procedure: U lesion set versus box lesion set. J Thorac Cardiovasc Surg, 2016, 151(4): 1062-1069.
14. Santhanakrishnan A, Okafor I, Kumar G, <italic>et al</italic>. Atrial systole enhances intraventricular filling flow propagation during increasing heart rate. J Biomech, 2016, 49(4): 618-623.
15. Cox JL, Ad N, Palazzo T. Impact of the maze procedure on the stroke rate in patients with atrial fibrillation. J Thorac Cardiovasc Surg, 1999, 118(5): 833-840.
16. Martínez-Comendador J, Gualis J, Marcos-Vidal JM, <italic>et al</italic>. Efficacy of oral anticoagulation in stroke prevention among sinus-rhythm patients who lack left atrial mechanical contraction after cryoablation. Tex Heart Inst J, 2015, 42(5): 430-437.
17. Badhwar V, Rankin JS, Damiano RJ Jr, <italic>et al</italic>. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
18. Baumgartner H, Falk V, Bax JJ, <italic>et al</italic>. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
19. 肖雄, 韩劲松, 王辉山, 等. 冷冻消融迷宫术治疗瓣膜病合并心房颤动的围术期管理. 中国体外循环杂志, 2018, 16(1): 29-32.
20. Calkins H, Hindricks G, Cappato R, <italic>et al</italic>. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 2017, 14(10): e275-e444.
21. Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
22. Kim KM, Chung S, Kim SY, <italic>et al</italic>. Comparison of radiofrequency ablation and cryoablation for the recovery of atrial contractility and survival. Korean J Thorac Cardiovasc Surg, 2018, 51(4): 266-272.
23. Cox JL. Intraoperative options for treating atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg, 2001, 122(2): 212-215.
24. Cox JL, Churyla A, Malaisrie SC, <italic>et al</italic>. When is a Maze procedure a Maze procedure? Can J Cardiol, 2018, 34(11): 1482-1491.
25. Abo-Salem E, Lockwood D, Boersma L, <italic>et al</italic>. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26: 1027-1037.
26. Brennan AP, Martin W, Adams H, <italic>et al</italic>. Impact of the Cox-Maze Ⅳ procedure on left atrial mechanical function. Heart Lung Circ, 2019, 28(12): 1835-1840.
27. Tinetti M, Costello R, Cardenas C, <italic>et al</italic>. Persistent atrial fibrillation is associated with inability to recover atrial contractility after MAZE Ⅳ surgery in rheumatic disease. Pacing Clin Electrophysiol, 2012, 35(8): 999-1004.
28. Jeon CS, Shim MS, Park SJ, <italic>et al</italic>. The absence of atrial contraction as a predictor of permanent pacemaker implantation after Maze procedure with cryoablation. Korean J Thorac Cardiovasc Surg, 2017, 50(3): 163-170.
29. Jeong DS, You JH, Jeon CS, <italic>et al</italic>. Impact of ablation duration on rhythm outcome after concomitant Maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30. Ghavidel AA, Javadpour H, Shafiee M, <italic>et al</italic>. Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation. Eur J Cardiothorac Surg, 2008, 33(6): 1043-1048.
31. Takasaki T, Sueda T, Imai K, <italic>et al</italic>. Mid-term results of the box pulmonary vein isolation and the cryo-Maze procedure for chronic atrial fibrillation associated with mitral valve disease. Gen Thorac Cardiovasc Surg, 2012, 60(2): 82-89.
32. Albåge A, Péterffy M, Källner G. The biatrial cryo-Maze procedure for treatment of atrial fibrillation: a single-center experience. Scand Cardiovasc J, 2011, 45(2): 112-119.
33. Vural Ü, Balcı AY, Ağlar AA, <italic>et al</italic>. Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation. Braz J Cardiovasc Surg, 2018, 33(6): 542-552.
34. Lönnerholm S, Blomström P, Nilsson L, <italic>et al</italic>. Long-term effects of the Maze procedure on atrial size and mechanical function. Ann Thorac Surg, 2008, 85(3): 916-920.
35. Wang M, Yip GW, Wang AY, <italic>et al</italic>. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol, 2003, 41(5): 820-826.
36. Loardi C, Alamanni F, Galli C, <italic>et al</italic>. Surgical treatment of concomitant atrial fibrillation: focus onto atrial contractility. Biomed Res Int, 2015, 2015: 274817.
37. Tsao HM, Hu WC, Tsai PH, <italic>et al</italic>. Functional remodeling of both atria is associated with occurrence of stroke in patients with paroxysmal and persistent atrial fibrillation. Acta Cardiol Sin, 2017, 33(1): 50-57.
38. Kim HK, Kim YJ, Kim KI, <italic>et al</italic>. Impact of the Maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112(9 Suppl): I14-I19.
39. Kim JB, Yun TJ, Chung CH, <italic>et al</italic>. Long-term outcome of modified Maze procedure combined with mitral valve surgery: analysis of outcomes according to type of mitral valve surgery. J Thorac Cardiovasc Surg, 2010, 139(1): 111-117.
40. Gillinov AM, Sirak J, Blackstone EH, <italic>et al</italic>. The Cox Maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(6): 1653-1660.
41. Kim HW, Moon MH, Jo KH, <italic>et al</italic>. Left atrial and left ventricular diastolic function after the Maze procedure for atrial fibrillation in mitral valve disease: degenerative versus rheumatic. Indian J Surg, 2015, 77(1): 7-15.
42. Bauer EP, Szalay ZA, Brandt RR, <italic>et al</italic>. Predictors for atrial transport function after mini-Maze operation. Ann Thorac Surg, 2001, 72(4): 1251-1254.
43. Kazui T, Henn MC, Watanabe Y, <italic>et al</italic>. The impact of 6 weeks of atrial fibrillation on left atrial and ventricular structure and function. J Thorac Cardiovasc Surg, 2015, 150(6): 1602-1608.
44. Li Z, Wang Z, Yin Z, <italic>et al</italic>. Gender differences in fibrosis remodeling in patients with long-standing persistent atrial fibrillation. Oncotarget, 2017, 8(32): 53714-53729.
45. Sunderland N, Maruthappu M, Nagendran M. What size of left atrium significantly impairs the success of maze surgery for atrial fibrillation? Interact Cardiovasc Thorac Surg, 2011, 13(3): 332-338.
46. Gan GCH, Ferkh A, Boyd A, <italic>et al</italic>. Left atrial function: evaluation by strain analysis. Cardiovasc Diagn Ther, 2018, 8(1): 29-46.
47. Curta A, Fichtner S, Wakili R, <italic>et al</italic>. Prospective evaluation of left atrial function and late gadolinium enhancement with 3 T MRI in patients with atrial fibrillation before and after catheter ablation. Int J Cardiovasc Imaging, 2019, 35(3): 499-504.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation

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