Impact of thermal ablation methods on sinus rhythm maintenance after mitral valve surgery in patients with atrial fibrillation

Figures

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  Figure 1. Surgical anatomy and ablation lines in the Cox-Maze IV procedure. Top: Right atrial view showing ablation lines from the superior vena cava to the inferior vena cava (blue) and additional lines across the atrial wall (orange). Bottom: Left atrial view illustrating ablation lines encircling the pulmonary veins (blue, a) and connecting to the mitral annulus and left atrial appendage. Blue lines represent lesion sets used for pulmonary vein isolation and interruption of atrial reentry circuits during AF surgery.

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  Figure 2. Kaplan-Meier curves for SR maintenance according to BMI. Patients with BMI ≥30 kg/m2 exhibited significantly lower SR survival compared to those with BMI <30 kg/m2 (log-rank p=0.0001). BMI: Body mass index; SR: Sinus rhythm.

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  Figure 3. Correlation analysis of clinical variables associated with atrial fibrillation recurrence after surgical ablation. Top left: Moderate positive correlation between BMI and AF recurrence (Pearson r=0.550). Top right: Weaker positive correlation between LAD and AF recurrence (Spearman r=0.382). Bottom right: Moderate negative correlation between LVEF and AF recurrence (Spearman r=-0.630). Correlation coefficients were considered statistically significant at p<0.05. BMI: Body mass index; LVEF: Left ventricular ejection fraction; AF: Atrial fibrillation; LAD: Left atrial diameter.

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  Figure 4. ROC curve analysis for predictors of AF recurrence. Left panel shows the ROC curve for left atrium diameter, and right panel shows the ROC curve for BMI. Both variables demonstrate predictive value for AF recurrence after surgical ablation, with optimal thresholds providing the highest sensitivity and specificity. ROC: Receiver operating characteristic; AF: Atrial fibrillation; BMI: Body mass index.