Evaluation of atrial contractility and remodeling after the Maze-3 procedure with combined heart interventions

Abstract

Highlights. The most important goal of atrial fibrillation surgical treatment is to eliminate the arrhythmia in order to restore atrial contractility and improve their transport function. Our study showed positive dynamics of atrial contractility and remodeling after the maze-3 procedure against the background of a regular heart rhythm restoration. The study of sinus rhythm predictors maintenance and recovery of atrial transport function will help to make patient selection more personified.Aim. Evaluation of atrial contractility and remodeling after the maze-3 procedure with combined interventions on the heart.Methods. The analysis of 217 combined surgical interventions was carried out, where a maze-3 was used to treat atrial fibrillation (AF). The operations were performed in our center from 2012 to 2016. Key points of the study: rhythm after surgery and echocardiographic control in the long-term follow-up in order to determine the dynamics of atrial contractility and volumes. The average follow-up period was 47 (1–100) months. 40 (18.4%) patients had paroxysmal, 38 (17.5%) persistent, 139 (64.1%) long-term persistent AF. The mean AF duration before surgery was 27.4 months (1–200 months). The indications for the maze-3 procedure were: ineffectiveness of antiarrhythmic therapy, the need to perform combined cardiac procedures. We used standard statistical research methods with one – and multivariate logistic regression.Results. In the long-term follow-up, sinus rhythm (SR) persists in 79% of patients. In the long-term follow-up, in this group of patients, the left atrial contractility was  restored  from  76%  to  91%,  while  the  biatrial  contractility  increased from 82 to 96%. Shorter AF duration before surgery was a positive predictor of SR recovery and atrial contractility (p = 0.005), while pulmonary artery pressure and patient age negatively affected these indicators (p = 0.041 and p = 0.038, respectively). The presence of SR early after surgery was not a significant predictor of AF freedom. At the same time, according to the long-term observations, patients maintaining a regular atrial heart rate had positive indicators of atrial systolic function restoration and a positive dynamics of a decrease in atrial volumes.Conclusion. SR and restoration of left atrial contractility are two interrelated goals of the maze procedure. The negative factors associated with the failure of surgical treatment of AF are increased pressure in the pulmonary artery, long-term AF before surgery, and the age of patients.