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Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery.
MedLine Citation:
PMID:  25443604     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF.
METHODS: Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography.
RESULTS: The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05).
DISCUSSION: In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function.
Sajid A Sayed; Ashish Katewa; Vivek Srivastava; Sujit Jana; Anil M Patwardhan
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Publication Detail:
Type:  Journal Article     Date:  2014-06-06
Journal Detail:
Title:  Indian heart journal     Volume:  66     ISSN:  0019-4832     ISO Abbreviation:  Indian Heart J     Publication Date:    2014 Sep-Oct
Date Detail:
Created Date:  2014-12-02     Completed Date:  -     Revised Date:  2014-12-04    
Medline Journal Info:
Nlm Unique ID:  0374675     Medline TA:  Indian Heart J     Country:  India    
Other Details:
Languages:  eng     Pagination:  510-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
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