Key result
Totally thoracoscopic maze achieves ~78% 1-year arrhythmia-free success off antiarrhythmic drugs with low complications.
Why the study?
What is the overall efficacy and safety of the totally thoracoscopic maze procedure for maintaining freedom from atrial arrhythmias in patients with atrial fibrillation?
Meta-Analysis (n=1,171)
What is the overall efficacy and safety of the totally thoracoscopic maze procedure for maintaining freedom from atrial arrhythmias in patients with atrial fibrillation?
The totally thoracoscopic maze procedure is a highly effective standalone surgical option for treating varying subtypes of atrial fibrillation, demonstrating a 78% 1-year off-drug success rate with low perioperative morbidity.
Answers are grounded in this paper and cite their sources.
May support thoracoscopic maze as standalone AF option with low morbidity; extends observational evidence but leaves open need for RCTs.
The purpose of this study was to update the current evidence regarding the efficacy and safety of the totally thoracoscopic maze (TT-maze) procedure for the treatment of atrial fibrillation (AF). Fourteen studies published between 2011 and 2016 and comprising 1171 patients were included as follows: 545 (46%) patients had paroxysmal AF (pAF), 268 (23%) persistent AF (persAF) and 358 (31%) longstanding persistent AF (LSPAF). Fixed- and random-effect models were used to calculate the pooled overall freedom from atrial arrhythmias. The 1- and 2-year pooled overall antiarrhythmic drug (AAD) free (off-AAD) success rates were 78% (95% confidence interval (CI): 72-83%, n = 13) and 77% (95% CI: 64-86%, n = 6), respectively. The 1- and 2-year pooled on-AAD success rates were 84% (95% CI: 78-89%, n = 5) and 85% (95% CI: 78-90%, n = 3), respectively. Subanalysis regarding the different types of AF revealed a 1-year pooled off-AAD success rate of 81% (95% CI: 73-86%, n = 7) for pAF, 63% (95% CI: 57-69%, n = 5) for persAF and 67% (95% CI: 52-79%, n = 3) for LSPAF. The overall in-hospital complication rate was <3% (n = 36). We conclude that the TT-maze is an effective strategy for the treatment of AF with maintained efficacy at the 2-year follow-up. Furthermore, the TT-maze has demonstrated similar efficacy to the Cox Maze IV procedure at the midterm follow-up with a lower complication rate. Extended follow-up research is needed to determine whether the high success rates after TT-maze will be stable over time.
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Laar et al. (2016) conducted a meta-analysis in Atrial fibrillation (paroxysmal, persistent, longstanding persistent) (n=1,171). Totally thoracoscopic maze (TT-maze) procedure was evaluated on Freedom from atrial arrhythmias (atrial fibrillation, atrial flutter, atrial tachycardia ≥30 s) off antiarrhythmic drugs at 1 year (78% pooled success rate, 95% CI 72-83). The totally thoracoscopic maze procedure achieved a 1-year pooled off-antiarrhythmic drug success rate of 78% for freedom from atrial arrhythmias, with an overall in-hospital complication rate of less than 3%.
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