A modified radial ablation approach yielded similar conversion to normal sinus rhythm (p>0.05) but better atrial transport function (A/E ratio 0.52 vs 0.36; p<0.05) than modified Cox's maze III.
RCT (n=80)
Single-blind
randomized
Does a modified radial approach improve conversion to normal sinus rhythm and atrial transport function compared to modified Cox's maze III in patients with continuous AF undergoing rheumatic valvular heart surgery?
In patients with continuous AF undergoing rheumatic valvular surgery, a modified radial ablation approach is as effective as the modified Cox's maze III for restoring sinus rhythm but provides better preservation of atrial transport function.
p-value: p > 0.05 for NSR; p < 0.05 for ATF
BACKGROUND: Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF. METHODS: Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography. RESULTS: The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05). DISCUSSION: In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function.
Sayed et al. (Fri,) conducted a rct in Rheumatic valvular heart disease with continuous atrial fibrillation (n=80). Modified radial approach vs. Modified Cox's maze III was evaluated on Conversion to normal sinus rhythm (NSR) and atrial transport function (ATF) (p=p > 0.05 for NSR; p < 0.05 for ATF). A modified radial ablation approach yielded similar conversion to normal sinus rhythm (p>0.05) but better atrial transport function (A/E ratio 0.52 vs 0.36; p<0.05) than modified Cox's maze III.