Long-term results of atrial maze surgery in patients with congenital heart disease

Abstract

Aims Recurrent atrial tachycardia is common after repair of many types of congenital heart disease, and surgical ablation with a maze procedure represents a potential treatment strategy. The objective of this study is to report a single-centre 19 years’ experience with maze surgery in congenital heart patients. Methods and results Patients undergoing maze procedure concomitantly with cardiac surgical procedures were retrospectively analysed. The maze procedure was classified as therapeutic if the patient demonstrated preoperative atrial arrhythmias, or as prophylactic if done because the patient was considered high risk for post-operative arrhythmias. Acute outcomes and longer-term freedom from atrial arrhythmias were analysed. Maze surgery was performed in 166 patients: 137 in the therapeutic group, and 29 in the prophylactic group. The most common congenital heart lesion was single ventricle for the therapeutic group (27%) and Ebstein’s anomaly for the prophylactic group (76%). Surgery consisted of a right atrial maze in 63%, left atrial maze in 4%, and bilateral maze in 33%. There were no direct complications or mortality related to the maze procedure itself. For the therapeutic group, freedom from arrhythmias was 82% and 67% at 1 and 5 years post-maze. Younger age at the time of surgery correlated with a lower long-term recurrence risk. Conclusion Maze procedure at the time of an elective anatomic surgery is reasonably effective to prevent and treat atrial arrhythmias in patients with congenital heart disease at short- and mid-term, with low morbidity and mortality.

New-onset postoperative atrial fibrillation after mitral valve surgery: Determinants and the effect on survival

“…Prophylactic surgical ablation has been reported for “high-risk” (such as rheumatic heart disease patients undergoing MV repair) procedures. 32 As these high-risk patient populations are rarely found within the United States, however, this prophylactic approach to prevent AF is not commonplace. PAF in the field of MV disease has great potential to reduce the incidence of PAF, reduce mortality, and improve the quality of life for patients undergoing MVS due to the high incidence of PAF in these patients and opportunities for concomitant prophylactic ablative therapy.…”

Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years

“…A 2019 Europace study reported on a single-centre’s 19 years’ experience with maze surgery in patients with CHD. 60 In this study, the maze procedure was classified as therapeutic if the patient demonstrated preoperative atrial arrhythmias, or as prophylactic if done because the patient was considered high risk for postoperative arrhythmias. A maze was performed on 137 subjects in the therapeutic group and 29 in the prophylactic group.…”

Risk factors for atrial arrhythmia recurrence after atrial arrhythmia surgery with pulmonary valve replacement

“…Atrial tachyarrhythmia commonly occurs in patients with adult congenital heart disease (ACHD) due to atrial volume, pressure overload, and surgical scars. 1 , 2 Atrial tachyarrhythmias can cause a deterioration in the quality of life and lead to heart failure and hospitalizations. 3 , 4 , 5 , 6 , 7 Therefore, it is essential to manage the cumulative lifetime risk of atrial tachyarrhythmia.…”

“…Previous studies have reported that the age at the time of arrhythmia surgery, duration of arrhythmia, Ebstein anomaly, and tetralogy of Fallot (TOF) were risk factors for atrial arrhythmia recurrence. 1 , 8 …”