095 Resumption of sinus rhythm post-modified maze is associated with left atrial contraction and possible progressive left atrial reverse remodeling

Abstract

We had previously demonstrated the safety and the efficacy of the modified MAZE procedure in restoring sinus rhythm in patients undergoing mitral valve and other cardiac surgeries. It remains unclear if sinus rhythm post-MAZE is associated with resumption of hemodynamically meaningful LA contraction and reverse LA remodeling. Modified MAZE procedure for chronic or persistent AF was performed with laser or radiofrequency source on 82 consecutive patients, mostly as part of mitral valve surgeries. 39 Patients were ablated in the left atrium only whereas the remaining 43 were ablated bi-atrially; left atrial appendectomy was performed in all patients. All received coumadin and were cardioverted in the perioperative period if found in AF. Most patients received antiarrhythmic therapy in the 3 months following their surgery; later it was discontinued whenever possible. Reports and images from post-operative echocardiograms up to 3 years were reviewed to obtain the cardiac rhythm during the studies and the presence of distinct A-waves on mitral inflow pulse wave doppler (MI-PWD). When available, mean LA size as measured on parasternal long axis (PSLX) were obtained from post-op echocardiograms at various points within the 3-year interval and were paired to their pre-op study for analysis. Of the 82 patients who underwent the modified-MAZE procedure (table1), 43 had documented sinus rhythm during their transthoracic echocardiogram and MI-PWD data was available in 39 for analysis. Mitral inflow A-waves were present in 100% of these patients. The overall mean LA size pre-op was 51+/−7mm vs 47+/−8mm at within 3 years post-operatively (n = 23, P = 0.06). There is trend towards progressive reduction in LA size at 1-week, 1-year and 2-year interval. (Fig1.)Tabled 1View Large Image Figure ViewerDownload Hi-res image Download (PPT) The recovery of sinus rhythm in patients undergoing modified MAZE-procedure plus LA appendectomy is always associated with resumption of hemodynamically meaningful atrial contraction. Furthermore, there is trend towards progressive LA reverse remodeling with the resumption of sinus rhythm.