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CLINICAL RESEARCH

Atrial Arrhythmias After Surgical Maze

Findings During Catheter Ablation

The Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio

Manuscript received February 21, 2006; revised manuscript received April 18, 2006, accepted May 8, 2006.

^_* Reprint requests and correspondence: Dr. Andrea Natale, Section of Pacing and Electrophysiology, Electrophysiology Laboratory, Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F 15, 9500 Euclid Avenue, Cleveland, Ohio 44195 (Email: natalea{at}ccf.org).

OBJECTIVES: We describe the clinical and electrophysiologic characteristics and management of post "cut and sew" Maze arrhythmias in symptomatic patients.

BACKGROUND: The Cox Maze procedure was developed as a surgical treatment of atrial fibrillation. Until recently, invasive electrophysiologic studies in patients with symptomatic post-operative arrhythmias in this patient population have not been described.

METHODS: The management and clinical course of consecutive patients with post-Maze arrhythmias refractory to antiarrhythmic drugs (AADs) between January 2000 and December 2003 are presented.

RESULTS: Twenty-three patients (15 men) presented 14 ± 14 months after Maze surgery for treatment of atrial fibrillation (AF). Eight patients underwent "cut and sew" Maze for lone AF with no other surgical indication. Fifteen patients underwent the "cut and sew" Maze procedure in addition to another surgical procedure: mitral valve surgery (11 patients) and coronary artery bypass graft surgery (4 patients). Eight patients (35%) had recurrent AF secondary to recovered conduction around the lines encircling the pulmonary veins. Five patients were documented to have focal atrial tachycardia, which was mapped to the coronary sinus in 3 patients, to the posterolateral right atrium in 1 patient, and to the left atrial (LA) septum in 1 patient. Four patients had right atrium incisional atrial flutter (AFL), and 6 had LA incisional AFL, which was mapped around the mitral valve annulus in 4 patients and around the right pulmonary veins in 2 patients. Twenty-two of the 23 patients were treated successfully with radiofrequency ablation. At 1-year follow-up, 19 patients were arrhythmia-free and taking no AADs.

CONCLUSIONS: After surgical "cut and sew" Maze, approximately one-third of patients experiencing atrial arrhythmias have AF secondary to pulmonary vein-left atrium conduction recovery. Moreover, incisional AFL seems to be a common finding in this group of patients. Catheter-based mapping and ablation of these arrhythmias seems to be feasible and effective.

Abbreviations and Acronyms   AAD = antiarrhythmic drug   AF = atrial fibrillation   AFL = atrial flutter   AT = atrial tachycardia   LA = left atrium/atrial

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