24 Month Event-Recorder Based Follow-up of Post-MAZE-Patients. Freedom From Atrial Fibrillation and Atrial Re-Remodeling Correlates with BMI Control and Afib Entity

Abstract

Background: Paroxysmal and persistent atrial fibrillations (Afib) are the most common cardiac arrhythmias. MAZE procedures reach freedom form atrial fibrillation (FFA) depending on the arrhythmogenic entity. Obesity associated atrial profibrotic remodeling contributes to Afib sustainability. Predictors for postoperative MAZE-success are vacant. Methods: In a prospective all comers study 109 patients with paroxysmal (n = 38) or persistent (n = 71) Afib underwent standardized MAZE (bipolar radiofrequency, eventrecorder(ER)) additive to baseline procedure. Patients underwent follow-up at our department each 6 month (2 years; electrocardiogram, ER-readout, echocardiography, blood-sample, physical examination). FFA was defined as single episode-duration less than 5 minutes and total amount of Afib lower 10% / 6 month. We offered electrophysiological heart-team-control in case of Afib-maintenance after 12 month. Results: We reached FFA in 97,2% of paroxysmal Afib (24 month). Persistent Afib endured stronger but reached FFA in 58,9% after 24 month. EuroScore II was 6,1 ± 0,7% (paroxysmal) and 6,4 ± 0,4% (persistent). 30-day mortality remained lower overall (5,3 ± 0,2%,paroxysmal; 4,1 ± 0,3%, persistent; p < 0,05 versus EuroScore). Neither Euro-, nor CHADS-score nor patient´s sex correlated with FFA significantly. In paroxysmal Afib FFA after 24 month reduced left atrial diameter (−6,7 ± 2,2 mm) and improved LVEF (+ 7,3 ± 2,8%) while patients remaining in fibrillation showed further atrial dilation (+ 8,0 ± 1,0 mm) and reduction of LVEF (−7,0 ± 1,3%) (p < 0,05), long-term changes were less distinct in persistent atrial fibrillation. Increased preoperative left atrial diameter reduced FFA in permanent Afib but had nearly no effect in paroxysmal Afib. In persistent, but not in paroxysmal Afib, FFA correlated negatively with patient age. All electrophysiological re-examined patients reached FFA. More interesting, FFA and duration of episodes after 6 to 24 month correlated negatively with BMI in all patients. Weight control and moderate weight reduction in obese patients consolidated FFA. Conclusion: Paroxysmal and persistent Afib exhibit structural and therapeutically characteristics. MAZE shows high therapeutically benefit even in high-risk-patients. Atrial re-remodeling can be achieved in paroxysmal Afib. Increased BMI reduces FFA consistently. Preoperative left atrial diameter, patient´s age and BMI may be used as predictors of therapeutically success in persistent Afib.