Long-term follow-up of atrial contraction after the Maze procedure in patients with mitral valve disease

OBJECTIVES We sought to determine the effectiveness of the maze procedure f or maintaining sinus rhythm and atrial contraction for a long period in pat ients with mitral valve disease. BACKGROUND Although the maze procedure for atrial fibrillation (AF) has bee n effective in restoring sinus rhythm in patients with mitral valve disease , the long-term results of this procedure have not been determined. METHODS We echocardiogaphically studied 94 consecutive patients with mitral valve disease before, as well as early (3.1 +/- 3.3 months) and late (2.2 +/- 0.9 years) after, the maze procedure. Peak velocity and the time-veloci ty integral of the left ventricular (LV) diastolic filling wave during atri al contraction (A wave), as well as the atrial filling fraction (calculated as the ratio of the time-velocity integral of the A wave to total diastoli c filling), were obtained from transmitral flow recordings. Peak A wave vel ocity greater than or equal to 10 cm/s was considered to indicate echocardi ographic evidence of effective atrial contraction. RESULTS Regular rhythm with P waves was restored in 70 patients (74%) in th e early stage and in 59 patients (63%, p = 0.09) in the late stage after th e maze procedure. Forty-seven patients (50%) in the early stage and 36 pati ents (38%, p = 0.14) in the late stage showed effective atrial contraction by Doppler echocardiography. Left atrial (LA) and LV end-diastolic diameter s significantly decreased after the procedure (from 59 +/- 13 to 48 +/- 7 m m, p < 0.01; and from 54 +/- 9 to 47 +/- 5 mm, p < 0.01, respectively) and did not show significant changes during the follow-up period. Once atrial c ontraction was resumed, its degree did not change between the early and lat e stages after the maze procedure (17 +/- 6% vs. 17 +/- 6% for atrial filli ng fraction). CONCLUSIONS Sinus rhythm and atrial contraction recovered early after the m aze procedure in most patients and were maintained for more than two years. Once active atrial contraction was resumed, the degree of contraction did not change thereafter. These results demonstrate that the maze procedure is effective for a long period in patients with mitral valve disease. (J Am C oll Cardiol 2001;37:1622-7) (C) 2001 by the American College of Cardiology.