The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium

Abstract

Although giant LA is known to be a predictor of poor outcomes after the maze procedure, younger patients had more favorable rhythm outcomes than older patients, as shown by the superior freedom from AF recurrence. A more aggressive surgical approach in younger patients might eliminate AF, even in the presence of a giant LA.

Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery

“…This rate seems to be lower than those of the previous studies performed on patients with valvular AF undergoing MV surgery,1 14 15 but comparable with those of other studies reporting AF-free rate after the maze procedure in patients with giant LA 2 5. This study also revealed that the AF-free rate was significantly lower among the patients with larger LA (≥70 mm) even within the maze group (p=0.014), which is consistent with the findings of previous reports that larger LA size is a significant predictor for late AF recurrence 1 16.…”

“…The presence of a giant LA has been reportedly associated with a high risk of AF ablation failure and a high rate of late AF recurrence after the maze procedure 2 5. Je et al 13 reported their series of 560 patients receiving maze procedures with major cardiac surgery, and demonstrated that LA size >60 mm was associated with a significantly higher risk for ablation failure (HR 1.72; CI 1.05 to 2.81; p=0.031).…”

“…This is because the restoration of sinus rhythm using this procedure in patients with enlarged atria has been reported to be suboptimal, and associated with a high failure rate and frequent late recurrence of AF. To date, however, there have been only few studies comparing the long-term clinical outcomes, such as safety and clinical efficacy, in this cohort 2 5…”

“…In particular, performing the maze procedure in patients with giant left atrium (LA) has not reached general consensus, and the risk–benefit profile of the procedure in this population has remained questionable 1 2. This is because the restoration of sinus rhythm using this procedure in patients with enlarged atria has been reported to be suboptimal, and associated with a high failure rate and frequent late recurrence of AF.…”

Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon

“…It was shown that age was a strong predictor of AF recurrence in patients with maze procedure and RF AF ablation [22][23][24][25]. Ageing leads to interstitial fibrosis and more extensive LA remodeling; therefore it increases the likelihood of additional AF triggers, which may predispose to recurrent AF after limited ablation.…”