Atrial Contraction Recovery after Left MAZE III Surgery

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Abstract

Introduction
Left MAZE III surgery has proven a high level of effectiveness in restoring the sinus rhythm. However, the effectiveness in restoring the atrial systole in individuals with structural heart disease and the prevalence of rheumatic disease are still uncertain areas.

Objective
To assess the effectiveness of the MAZE surgery in restoring the atrial systole in patients with structural heart disease.

Material and Methods
We conducted a prospective and consecutive study in 27 patients with persistent or chronic atrial fibrillation with indication of cardiovascular surgery, who underwent MAZE technique for treating the arrhythmia. The presence of atrial systole was assessed by lateral mitral annular tissue Doppler imaging.

Results
In a population characterized by rheumatic heart disease predominance (41%) and long arrhythmia evolution (61 months on average), 87% individuals had sinus rhythm and 80% had mechanical activity at the end of the follow-up. A history of rheumatic heart disease, an arrhythmia lasting more than 5.5 years, the fact of being female, and mitral valve replacement were statistically significant variables, considering the absence of atrial systole. Factors like age, left ventricle ejection fraction, and left atrial size were not significant.

Conclusion
In this population, the absence of correlation between the sinus rhythm and the atrial systole is significant. Tissue Doppler imaging is a useful method to identify those patients with no atrial contraction. The clinical impact of this finding is related to the decision on continuing the anticoagulant therapy.