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CLINICAL STUDIES

Transient sinus node dysfunction after the Cox-maze III procedure in patients with organic heart disease and chronic fixed atrial fibrillation

^a Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefässchirurgie, Berlin, Germany

Manuscript received September 2, 1997; revised manuscript received May 21, 1998, accepted June 3, 1998.

Address for correspondence: Dr. Miralem Pasic, Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefässchirurgie, Augustenburger Platz 1, D-13353 Berlin, Germany
pasic{at}DHZB.DE

Objectives. This prospective study examined types, frequency and time dependency of the electrophysiologic manifestation of the sinus node dysfunction after the Cox-maze III procedure—the technique of choice for the management of medically refractory atrial fibrillation—in patients with organic heart disease, chronic fixed atrial fibrillation and no preoperatively overt dysfunction of the sinus node.

Background. The original maze procedure was modified twice in order to reduce the high incidence of the sinus node inability to generate an appropriate sinus tachycardia in response to maximal exercise, and occasional left atrial dysfunction. Despite these modifications, postoperative disturbance of sinus node function can be frequently observed.

Methods. In 15 adult patients, standard electrocardiogram, 24-h Holter monitoring, power spectral analysis of heart variability, exercise testing, Valsalva maneuver and rapid positional changes were performed 3, 6 and 12 months after the Cox-maze III procedure and mitral valve surgery or closure of atrial septal defect.

Results. Electrocardiographic manifestations of sinus node dysfunction were identified in 12 patients at 3 months, in 6 patients at 6 months, and in 0 patients at 12 months after surgery. The heart rate response to exercise during the first 6 months was reduced in the maze group and became fully normal at 12 months. Power spectral analysis of heart rate variability showed very low power values at 1 month with inhibited cardiac autonomic activity and no response on sympathetic stress. A potential of recovery of cardiac autonomic activity was documented 12 months after surgery.

Conclusions. The manifestations of sinus node dysfunction following the Cox-maze III procedure were time dependent and their frequency and intensity progressively decreased and disappeared within 12 months after surgery.

Abbreviations and Acronyms   TEE = transesophageal echocardiography   LF = the spectral power of low-frequency of heart variability   HF = the spectral power of high-frequency of heart variability

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