Abstract
ObjectiveTo evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation.MethodsAll patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model.ResultsWe enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127–1.874), area under ROC curve was 0.81, the Jordan index was 0.665.ConclusionThe severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.
Highlights
Atrial fibrillation (AF) is one of the most common arrhythmias clinical practice
According to whether Sinus bradycardia (SB) occurs after the Maze procedure
The bi-atrial Maze procedure (MP) was performed in 82 patients
Summary
Atrial fibrillation (AF) is one of the most common arrhythmias clinical practice. Atrial fibrillation is common in patients with valvular disease, which could further cause thromboembolism or even heart failure, seriously affecting the patient’s quality of life, leading to high disability and mortality rates [1]. The Cox-Maze procedure (MP) is a well-established method. Bipolar radiofrequency ablation, known as Cox-Maze IV procedure (CM-IV), is widely used in the surgical treatment of AF [5,6,7]. The development of symptomatic bradyarrhythmia is a major complication of Cox-Maze IV procedure, which can lead to fatal or necessitate pacemaker implantation. Age, extended lesion set, and microwave energy source were identified as predictors of sinus node dysfunction or bradyarrhythmia. Sinus bradycardia (SB) has been shown to be the main type of bradyarrhythmia [8, 11,12,13]
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