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Maze 3 for Atrial Fibrillation : Two Cuts Too Few?
Author(s) -
TSUI S.S.L.,
GRACE A.A.,
LUDMAN P.F.,
SCHOFIELD P.M.,
PAGE A.J.P.,
ROWLAND E.,
LARGE S.R.
Publication year - 1994
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1994.tb03819.x
Subject(s) - medicine , atrial fibrillation , cardiology , sinus rhythm , atrial flutter , atrium (architecture) , normal sinus rhythm , left atrium , anesthesia
The Maze procedure has been developed as a surgical approach to the management of patients with atrial fibrillation refractory to medical treatment. The recent modification of the technique (Maze 3) achieves good rate control with coordinated AV contractions. However, the procedure involves cuts that completely isolate a block of left atrial (LA) wall, including the four ostia of the pulmonary veins. The electrical and mechanical activity of this isolated LA block are dissociated from the rest of the atrium, and the area may, in fact, continue to fibrillate. This may provide a nidus for the development of mural thrombus. The weight and endocardial surface area of the LA block and of the entire LA were estimated in ten formalin fixed hearts from trauma victims with no evidence of cardiac disease. In these samples, the LA block represented 35% of the endocardial surface area of the entire LA and 29% of the weight. The LA block is of sufficient size to allow macroreentrant circuits to form and has the potential to fibrillate if isolated from the rest of the atrium. We modified the Maze 3 procedure to recruit the otherwise isolated LA block by using two additional cuts around each pair of pulmonary veins as they enter the LA. The first patient who underwent the modified procedure demonstrated sinus rhythm on Holter monitoring postoperatively and remained in sinus rhythm following burst atrial pacing at 300 and 420 beats/min each for 30 seconds. In addition, atrial contractions were found to contribute 19% of the cardiac output. The majority of the atrial wall and, in particular, the recruited area between the pulmonary veins contracted well, as demonstrated by transesophageal echocardiography. We suggest that this modification of Maze 3 has a potential advantage over the standard procedure by recruiting the entire LA without leaving any dyskinetic endocardial surface for thrombus formation. This should in turn reduce the risk of thromboembolic complications.