Key result
Modified maze with superior connecting lesion and CS ablation linked to ~34% higher sinus rhythm maintenance.
Why the study?
Does adding a box lesion and coronary sinus ablation improve maintenance of sinus rhythm in patients undergoing the modified maze procedure for atrial fibrillation?
Cohort (n=61)
Does adding a box lesion and coronary sinus ablation improve maintenance of sinus rhythm in patients undergoing the modified maze procedure for atrial fibrillation?
Adding a superior connecting lesion (box lesion) and coronary sinus ablation to the modified maze procedure significantly improves the maintenance of sinus rhythm at 6 months.
Answers are grounded in this paper and cite their sources.
May improve short-term sinus rhythm maintenance after modified maze; hypothesis-generating, requires randomized confirmation before practice change.
The modified maze procedure using radiofrequency devices has become an increasingly common surgical option for patients with atrial fibrillation. Several lesion sets have been proposed and tested, but it remains unclear which yields the best results. We studied 61 patients who underwent the modified maze procedure using radiofrequency devices from March 2005. The pulmonary veins were isolated separately on both sides, and a connecting lesion was made inferiorly in the early series of 30 patients (group 1). In 31 patients (group 2) treated from May 2007, we added a superior connecting lesion between both pulmonary veins (completing a box lesion), and also performed coronary sinus ablation from the epicardial side, using a monopolar device. At 6 months postoperatively, maintenance of sinus rhythm with and without antiarrhythmic medications was 70% and 63%, respectively in group 1, and 94% and 90% in group 2 (both p<0.05). Multivariate analysis indicated that the box lesion with coronary sinus ablation was an independent predictor of the maintenance of sinus rhythm at 6 months. These 2 lesions should not be eliminated from the modified maze procedure.
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Minakata et al. (2011) conducted a cohort in Atrial fibrillation (n=61). Modified maze procedure with box lesion and coronary sinus ablation vs. Modified maze procedure with separate pulmonary vein isolation and inferior connecting lesion was evaluated on Maintenance of sinus rhythm with antiarrhythmic medications at 6 months (p=<0.05). Adding a superior connecting lesion and coronary sinus ablation to the modified maze procedure increased maintenance of sinus rhythm at 6 months from 70% to 94%.
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