Surgical Ablation Of Atrial Fibrillation In Patients With A Giant Left Atrium Undergoing Mitral Valve Surgery

Objective: As the success of surgical ablation for atrial fibrillation(AF)is reported to be suboptimal for patients with giant left atrium(GLA),Its routine use on this population has remained controversial.We sought to evaluate the clinical outcomes of patients with a giant left atrium undergoing mitral valve surgery with/without the maze procedure?Methods: We identified 53 patients with GLA(left atrium dimension?65mm)and AF on electrocardiogram and echocardiographic eavluation,of which undergoing mitral valve surgery between january 2010 and march 2016 registered in the second hospital of shanxi medical university cardio-thoracic surgery.of these,23 underwent mitral valve surgery with maze procedure(maze group),whereas 30 underwent mitral valve surgery only(non-maze group).except for death case,all the patients followed more than one year afteroperation.by using statistical analysis to test the difference between restoration of sinus,the incidence of major event,overall survival rate in both group.Results: There was no statistically significant difference between the two groups in general information such as age,sex,duration of atrial fibrillation,left atrial size,and cardiac function.The cardiopulmonary bypass time and aortic cross-clamping time in the maze operation group was higher than that in the non-maze operation group.There were no deaths in the early maze operation group,6 patients with complications(including low cardiac output syndrome,hemodialysis,surgical bleeding requiring re-exploration,need to intervene pericardial effusion,surgical site wound problem,permanent pacemaker implantation);Non-maze surgery group died in 2 cases,5 patients with complications(low cardiac output syndrome,surgical bleeding requiring re-exploration,need to intervene pericardial effusion,surgical site wound problem),There was no significant difference in the incidence of complications between the two groups.In the Mid-term follow-up,There were no death in the non-maze operation group.2 cases of thromboembolic events occurred and 3 cases suffered from major events(2 cases For the anticoagulation-related bleeding,1 case of heart failure required re-hospitalization);There were no death in the maze surgery group,1 cases of thromboembolic events occurred and 2 cases suffered from major events(1 cases For the anticoagulation-related bleeding,1 case of heart failure required re-hospitalization).There was no significant difference in the overall survival rate and the incidence of major events between the two groups(P> 0.05).The cumulative rate of successful treatment of atrial fibrillation was69.6% in the maze group,which was significantly higher than that in the non-maze operation group(25.0%).The difference was significant(P <0.001).Conclusion:In patients with giant left atrium associated with atrial fibrillation undergoing mitral valve surgery,additional maze surgery can improve the success rate of postoperative sinus rhythm,and does not increase the incidence of early postoperative complications.Wether the increased success rate of sinus rhythm can be converted into long-term clinical benefits need to further large sample,long-term follow-up study.