MAZE PROCEDURE FOR ATRIAL-FIBRILLATION - INITIAL EXPERIENCE

Introduction and objectives. The MAZE procedure was developed as a sur gical approach to the management of patients with atrial fibrillation refractory to medical treatment. This study seeks to identify the risk and benefits of adding the MAZE procedure in patients with atrial fib rillation undergoing surgery for underlying organic cardiac disorders. Material and methods. Since november 1993, we have performed 10 inter ventions with the MAZE procedure, for the treatment of refractory atri al fibrillation. The indication to perform the technique,vas systemic embolism in 5 patients, contraindication for the anticoagulant treatme nt in two cases and no response to antiarrhythmic treatment in 5 cases . Two patients had more than one indication. In all the cases another surgical procedure was performed, 5 replacements of mitral valve, a mi tral repair, one tricuspid repair and tree repairs of an atrial septal defect. Results. Soon after surgery 9 patients were in sinus rhythm, and one in atrial fibrillation. Four patients needed atrial pacing dur ing the first days. One patient required a pacemaker due to symptomati c sinus bradycardia. During the first 3 months, 4 patients had episode s of paroxysmal atrial fibrillation and flutter. One patient died sudd enly one month after surgery. Seven patients have completed two years of follow-up, and are in stable sinus rhythm, in functional class I an d free of antiarrhythmic drugs. AU of them have echocardiographic evid ence of mechanical activity in both atria. Left atrium had been reduce d from 5.3 +/- 0.7 cm to 4.5 +/- 0.7 cm (p < 0.05). No patient has pre sented new embolic events. Conclusions. The MAZE procedure is a good c hoice in selected patients with atrial fibrillation refractory to medi cal treatment, or a precedent of systemic embolism. However, several p roblems can complicate the patient's course.