Left Atrial Contractile Function Following a Successful Modified Maze Procedure at Surgery and the Risk for Subsequent Thromboembolic Stroke

Abstract

Absence of LA contraction and LA volume index ≥33 ml/m(2) result in a significant increase in the risk for thromboembolic stroke after the Maze procedure for patients in sinus rhythm.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…The role of the LAA has been clouded by small numbers of patients and the continuation of anticoagulation in a minority of postoperative patients, as well as a retrospective series suggesting a persistent stroke risk in postoperative patients who are in sinus rhythm, with large atria, and poor atrial contraction leading to effective LA asystole. 1312 …”

Effect of Left Atrial Activity After the Maze Procedure on Clinical and Echocardiographic Outcomes

“…The recovery of LA activity may also contribute to the prevention of AF-related stroke or thromboembolism 18,19 by increasing the blood flow velocity in the LA. 20 According to a recent study by Buber et al, 47 (31%) of 150 patients with recovered SR after the maze operation showed no evidence of LA mechanical contraction at 3-month follow-up echocardiography and the absence of LA contraction resulted in a significant increase in the risk for thromboembolic stroke in patients with SR. 21 In our data incorporating only cryo-maze cases to ensure homogeneity of the study population, lack of LA activity was also associated with an increased risk of thromboembolic stroke in the univariate analysis. However, the significant association was not maintained in the multivariate analysis.…”

Development of Left Atrial Thrombus and Subsequent Cardioembolic Stroke in a 21-Year-Old Man With Ebstein Anomaly Who Previously Underwent Pulmonary Vein Isolation Ablation and Cox Maze III Procedure

“…Multivariate analysis demonstrated that the lack of LAMF was associated with a 5-fold increase in the risk for stroke (P=0.02). 16 The current case study involves a patient whom underwent pulmonary vein isolation, and the Cox maze III procedure, as well, and had a marked absence of LAMF postoperatively. This case illustrates the importance of evaluating LAMF after the Cox maze procedure or pulmonary vein isolation to determine the length of anticoagulation needed to prevent thromboembolic sequelae.…”

“…An investigation of 150 patients who underwent either radiofrequency or cryoablation maze procedures revealed that, at a mean follow-up of 24.5 months, 47 (31%) patients lacked LAMF. 16 Moreover, lack of LAMF was associated with a 5-fold increase in the risk of stroke (P=0.02). 16 The absence of LAMF after the Cox maze III procedure is as high as 39% 17 and has been demonstrated to persist up to 56 months.…”

“…16 Moreover, lack of LAMF was associated with a 5-fold increase in the risk of stroke (P=0.02). 16 The absence of LAMF after the Cox maze III procedure is as high as 39% 17 and has been demonstrated to persist up to 56 months. 18 Moreover, the specific type of surgical intervention used may impact the degree of postoperative LAMF.…”