IS ATRIAL-FIBRILLATION RESULTING FROM RHEUMATIC MITRAL-VALVE DISEASE A PROPER INDICATION FOR THE MAZE PROCEDURE

Background. There are a few patients without detectable atrial contrac tion despite restoration of atrial rhythm after the maze procedure for atrial fibrillation (AF) associated with mitral valve disease. Method s. From January 1995 to March 1997, 29 consecutive patients with AF as sociated with mitral valve disease underwent our modified maze procedu re combined with mitral or other valve operations. The causes of mitra l valve disease were rheumatic mitral stenosis (n = 22) and nonrheumat ic mitral regurgitation (n = 7). The 17 patients with postoperative at rial rhythm were divided into group I with rheumatic mitral stenosis ( n = 10), and group II with mitral regurgitation of nonrheumatic origin s (n = 7). Results. Seventeen patients regained atrial rhythm, 2 patie nts had junctional rhythm, and another 10 remained in AF. Between the group of patients with restoration of atrial rhythm and that of patien ts remaining in AF, significant differences were found in the percenta ge with rheumatic disease, history of AF, and maximum f-wave voltage. The postoperative peak velocity of the atrial filling wave to peak vel ocity of early filling wave ratio for the left atrium measured using D oppler echocardiography was 0.25 in group I, which was significantly l ower than that (0.42) in group II. Conclusions. Reconsideration of the indications for the maze procedure for AF associated with rheumatic m itral stenosis may thus be reasonable, particularly for cases in which replacement using a prosthetic valve is necessary, but we believe tha t patients with nonrheumatic mitral valve disease, especially those ab le to undergo reconstructive operations, are the best candidates for t he maze procedure. (C) 1998 by The Society of Thoracic Surgeons.