Steenmeijer, R. (Rik) (2012) Langetermijnresultaten en voorspellers van succes van radiofrequent gemodificeerde Maze-chirurgie als aanvullingop coronaire bypass- en klepchirurgie bij patiënten met atriumfibrilleren. thesis, Medicine.
Full text available on request.Abstract
Introduction: atrial fibrillation is the most common cardiac arrhythmia and its prevalence is expected to be doubled before the year 2040. Atrial fibrillation is associated with a two-fold increase in mortality and a three-fold increase in developing stroke. Therefore, it is of great importance to try to cure atrial fibrillation. One of the many available treatment possibilities is the surgical ablation technique. During the past decades, several surgical techniques have been designed to treat atrial fibrillation, especially applied at patients undergoing concomitant cardiac surgery. One of the methods used frequently nowadays is the radiofrequency modified Maze procedure. The results of this specific type of surgery are promising but there is some conflicting evidence in the literature. It is also not yet been elucidated which group of patients benefits most from this specific type of surgery. Aims: to determine the long-term success of concomitant radiofrequency modified Maze surgery in patients with atrial fibrillation and to identify predictors of success of this procedure. Material and methods: all patients who underwent radiofrequency modified Maze procedure between late 2003 and late 2010 as an adjunct to the open heart operation were identified and analysed retrospectively from available (digital) health records. Data from referring hospitals were obtained there. Preoperative as well as some postoperative variables were analysed uni- and multivariate to determine predictors for recurrence of atrial fibrillation or for sustained sinus rhythm. Results: a total of 338 patients were identified. The in-hospital mortality was 3.5% and during a mean follow-up of 41.3 months (range 0.33-96 months), 70 patients died (20.7%). The survival curve for mortality did not differ significantly between the group with postoperative sinus rhythm and the group with recurrence of atrial fibrillation. There were no Maze related complications and during complete follow-up, 3.9% developed a stroke. Sinus rhytm or atrial rhythm was present in 63% of the patients at 1 year and in 51.0%, 36.0% and 39.0% after 3, 5 and 7 year, respectively. Uni- and multivariate predictors of recurrence of atrial fibrillation were duration of atrial fibrillation, permanent atrial fibrillation, atrial dilatation, diabetes mellitus, atrial fibrillation right after surgery, atrial fibrillation at discharge, an electrocardioversion in the follow-up and persistent valvular disease. Paroxysmal and persistent atrial fibrillation were univariate predictors of success of the procedure. Echocardiographic atrial dimensions were greatly enlarged before the procedure. In the group who obtained sustained sinus rhytm, atrial dimensions decreased during follow-up. In the group recurrence of atrial fibrillation, there was at first a decrease, followed by an increase in atrial dimensions. Conclusions: in this study, without any selection bias, the long-term efficacy of the radiofrequency modified Maze procedure is somewhat disappointing. We identified uni- and multivariate pre- and postoperative predictive factors for recurrent atrial fibrillation, that is duration of atrial fibrillation, permanent atrial fibrillation, atrial dilatation, diabetes mellitus, early recurrence of atrial fibrillation after surgery, atrial fibrillation at discharge from the hospital, electrical cardioversion during follow-up and persistent valvular disease after surgery. On the other hand, preoperative paroxysmal and persistent atrial fibrillation were predictors of success of the radiofrequency modified Maze procedure. Although this procedure can be safely used to treat atrial fibrillation in patients undergoing open heart surgery, we would like to stress that preoperative patient selection is very important to increase the success rate of the radiofrequency modified Maze procedure. Looking at the shortcomings of this study, we recommend a future prospective research with a control group of patients who are not undergoing Maze surgery.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Elvan, Dr. A. cardioloog and Afdeling: Cardiologie, Isala klinieken te Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1262 |
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