Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery

Figure 1. Flow diagram of the study population and summary of surgical procedures. MVS indicates mitral valve surgery; PPM, permanent pacemaker; and SSS, sick sinus syndrome.

Figure 2. Impact of the additive maze procedure on the development of sick sinus syndrome (A) and atrioventricular block (B) and their temporal patterns.

Figure 3. Time‐to‐event curves for adverse clinical events. The composite clinical outcomes included death, stroke, and hospital admission. A, Patients who developed sick sinus syndrome (SSS) during follow‐up showed higher event rates during follow‐up. The overall mortality was not significantly different (B); however, patients with SSS development showed higher rates of stroke (C) and rehospitalization (D).

Figure 4. Time‐to‐event curves showing the impact of rheumatic pathological features on clinical outcomes. Patients with rheumatic mitral valve disease were not at a higher risk of sick sinus syndrome development (A), permanent pacemaker implantation (B), recurrent atrial fibrillation (AF; C), or composite clinical outcomes (death, stroke, and rehospitalization; D).

Figure 5. Impact of the lesion extent of the maze procedure (biatrial vs left atrial [LA]) on the long‐term outcomes stratified according to the presence of moderate‐to‐severe tricuspid regurgitation (TR). Overall, the biatrial maze procedure resulted in higher rates of sick sinus syndrome (SSS) development (A) and atrial fibrillation (AF) recurrence (B). C and D, In patients with mild or no TR, the biatrial maze procedure resulted in a higher rate of SSS development with a similar rate of recurrent AF. E and F, In patients with moderate‐to‐severe TR, there was no difference in the SSS development or recurrent AF according to the lesion extent of the maze procedure.