Long-term results of the maze procedure with GP ablation for permanent atrial fibrillation

• Published in: General thoracic and cardiovascular surgery 2021-02, Vol.69 (2), p.230-237
• Main Authors: Yamanaka, Kazuo, Nishina, Takeshi, Iwakura, Atsushi, Fujita, Masatoshi
• Format: Article
• Language: English
• Subjects: Ablation; Antiarrhythmics; Anticoagulants; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Catheter Ablation; Coronary vessels; Heart surgery; Humans; Maze Procedure; Medicine; Medicine & Public Health; Nervous system; Original Article; Pacemakers; Postoperative Period; Pulmonary Veins - surgery; Sinuses; Surgical Oncology; Thoracic Surgery; Treatment Outcome; Veins & arteries
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01438-8

Objectives We investigated the effect of the maze procedure with intensive pulmonary vein isolation (PVI) guided by ganglionated plexus (GP) mapping (the Maze with GP ablation group) on a long-term postoperative maintenance of sinus rhythm in patients with permanent atrial fibrillation (AF) and compared with that in patients undergoing the maze procedure with the conventional PVI (the Maze group). Methods and results We investigated 48 patients who underwent the maze procedure with GP ablation for persistent AF and 43 patients who underwent the maze procedure. The Maze procedure was conducted by the endocardial application of bipolar radiofrequency ablation and cryoablation. Conventional PVI was applied three times for the entrance of right and left PVs, respectively. Intensive PVI for GP ablation was repeated six-to-eight times for both sides of PVs to cover the bilateral GP regions identified by GP mapping. The duration of permanent AF, the prevalence of concomitant primary heart diseases, and the postoperative follow-up period were comparable between the two groups. At discharge, 1 year, 5 years after the surgery, sinus rhythm was maintained in 74.4%, 61%, and 40.5% of the Maze group. In contrast, it was maintained in 93.7%, 88.9%, and 75.7% of the Maze with GP ablation group. The cumulative freedom rate from AF at 10 years after surgery was significantly higher in the Maze with GP ablation group. Conclusions More intense PV isolation including adjacent GP may improve long-term results of maze procedure in patients with permanent AF.