PREDICTORS OF SINUS RHYTHM RESTORATION AFTER COX MAZE PROCEDURE CONCOMITANT WITH OTHER CARDIAC OPERATIONS

Background. There have been sporadic cases of persistent atrial fibril lation and sick sinus syndrome after the maze procedure. The purpose o f this study was to identify the predictors of sinus rhythm restoratio n after operation. Methods. Between March 1993 and June 1995, we evalu ated retrospectively 96 consecutive patients who underwent the maze pr ocedure (maze III) in combination with another type of cardiac operati on. Four patients who died and 6 patients who required permanent pacem aker implantation because of sick sinus syndrome were excluded. Ambula tory electrocardiographic monitoring was evaluated 1 year after operat ion. Multiple logistic regression analysis was applied to identify the predictors of sinus rhythm restoration. Results. The final population comprised 86 patients (mean age, 59.8 years; 67 patients with mitral valve disease). Overall, sinus rhythm was restored in 68 of 86 patient s (79.1%). The magnitude of the atrial fibrillatory wave positively pr edicted postoperative sinus rhythm restoration. Conversely, left atria l diameter was inversely related to postoperative sinus rhythm restora tion. The odds ratio of having both a fine atrial fibrillatory wave (< 1.0 mm) and enlarged left atrial diameter (greater than or equal to 65 mm) for patients with sinus rhythm restoration was 0.04 (95% confiden ce interval, 0.01 to 0.28). Conclusions. Atrial fibrillatory wave and left atrial diameter were independent predictors of sinus rhythm resto ration after the maze procedure in patients with chronic atrial fibril lation and organic heart disease. (C) 1997 by The Society of Thoracic Surgeons.