Temporary loss of cardiac autonomic innervation after the maze procedure

• Published in: European journal of cardio-thoracic surgery 1997-07, Vol.12 (1), p.75-81
• Main Authors: VOGT, P. R, BRUNNER LA ROCCA, H.-P, CANDINAS, R, GASSER, J, ZÜND, G, SCHÖNBECK, M, GENONI, M, TURINA, M. I
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atrial Fibrillation - surgery; Autonomic Denervation; Autonomic Nervous System; Biological and medical sciences; Chronic Disease; Exercise Test; Heart - innervation; Humans; Medical sciences; Middle Aged; Mitral Valve Insufficiency - surgery; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)00080-8

OBJECTIVE: Blunted sinus node response to exercise has been reported after the maze operation. We suggested the autonomic vegetative function of the heart to be disturbed after the maze procedure. METHODS: 17 patients, mean age 63 ± 15 years, with chronic atrial fibrillation for 49 ± 46months (range 5-65) underwent the maze procedure during mitral valvesurgery. Bicycle stress test, 24-h electrocardiography and heart ratevariability were analysed in 11 patients after three and in six after 14± 3 months. Spectral analysis within two frequency bands, vector analysis of the main circular resultant and influence of orthostasis and Valsalva manoeuvre on different R-R intervals were calculated. RESULTS: One patientdied from a perioperative ischaemic stroke. At follow-up, all patients werein sinus rhythm. Heart rate reached 84 ± 14%, the mean circular resultantwas 60 ± 48%, the ratio of the longest to the shortest R-R interval during the Valsalva manoeuvre was 92 ± 8% and the ratio of maximal tominimal R-R interval after orthostasis was 98 ± 4% of the age-adjusted normal value. Maximal workload was 116 ± 31 watts. All patients hadabnormal heart rate variability. Heart rate variability was significantly more blunted after three months, than after 14 months (P < 0.05). The minimal heart rate and the difference between the maximal and the minimal heart rate during the 24-h electrocardiography were significantly correlated to the number of normal physiological tests (r = -0.52; P