MAZE PROCEDURE FOR ATRIAL-FIBRILLATION ASSOCIATED WITH ATRIAL SEPTAL-DEFECT

Background-Atrial fibrillation (AF) is a relatively common complicatio n in elderly patients with an atrial septal defect (ASD). However, use of the simultaneous maze procedure for AF associated with ASD remains controversial. We examined the efficacy and risk of the use of the ma ze procedure in these patients. Methods and Results-Between March 1992 and April 1997, 26 patients underwent the maze procedure as a concomi tant operation with ASD closure (maze group). Kosakai's modified maze procedure was performed in 17 patients, the modified Cox maze II or II I procedure was performed in 6, and the restrictive right-sided maze p rocedure was performed in 3. The mean+/-SD age at surgery was 58.2+/-9 .1 years. The mean+/-SD duration of AF was 7.8+/-8.5 years, The mean+/ -SD left atrial dimension was 47+/-9 mm, and 24 patients (92%) had a l arger-than-normal (>35 mm) left atrium. The mean+/-SD follow-up period was 2.7+/-1.7 years. There were no hospital or late deaths. There was no thromboembolic episode in the late follow-up period. Sinus rhythm was regained in all patients who underwent conventional the right- and left-sided maze procedure except for 1 patient. However, 3 patients w ho underwent the restrictive right-sided maze procedure showed a retur n to AF rhythm. The atrial A wave was detected with the use of pulsed Doppler study in all patients who had a restored sinus rhythm. During the same period, 45 patients who were >40 years old and without AF und erwent only ASD closure (control group). The incidence of reopening th e chest for bleeding was significantly (P=0.046) higher in the maze gr oup (12%) than in the control group (0%). Paroxysmal AF more frequentl y (P=0.023) occurred in the control group (18%) than in the maze group (0%). Conclusions-These results suggest that the standard maze proced ure should be considered in patients with AF associated with ASD. The restrictive right-sided maze procedure was not reliable, probably due to preoperative enlargement of the left atrium.