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Surgery Today
Published in: Surgery Today 5/2018

01-05-2018 | Original Article

Predictors of the need for pacemaker implantation after the Cox maze IV procedure for atrial fibrillation

Authors: Naoki Masaki, Shunsuke Kawamoto, Naotaka Motoyoshi, Osamu Adachi, Kiichiro Kumagai, Satoshi Kawatsu, Yukihiro Hayatsu, Shintaro Katahira, Katsuhiro Hosoyama, Masatoshi Akiyama, Yoshikatsu Saiki

Published in: Surgery Today | Issue 5/2018

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Abstract

Purpose

The Cox maze IV (CMIV) procedure is being used increasingly frequently for surgical ablation of atrial fibrillation (AF). This study aimed to identify the risk factors of the need for postoperative pacemaker implantation (PMI) after CMIV.

Methods

Preoperative, intraoperative, and postoperative data were retrospectively collected from 67 consecutive patients who underwent CMIV at our institution; 7 (10.4%) required PMI (as a treatment of brady AF or sick sinus syndrome).

Results

Patients who needed PMI tended to have lower preoperative heart rates than those who did not on a 12-lead electrocardiogram (ECG; 68.7 ± 11.6 vs. 79.1 ± 18.5 bpm, p = 0.07) and a 24-h ECG (94,772 ± 9800 vs. 109,854 ± 19,078 beats/day, p = 0.03). A multivariate analysis identified a low amplitude of the fibrillatory wave on preoperative ECG as a risk factor of PMI necessity after CMIV [odds ratio = 14.7; 95% confidence interval (CI) 1.9–324.7; p = 0.007] and internal use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) as a negative risk factor (odds ratio = 0.16; 95% CI 0.02–0.99; p = 0.049).

Conclusions

A low amplitude of the fibrillatory wave was identified as a risk factor of PMI necessity, whereas the internal use of ACEIs/ARBs diminished the need for PMI. These factors should be considered before CMIV is performed.
Literature
1.
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation. Circulation. 2006;114:e257–e354.CrossRefPubMed
2.
Nitta T, Ishii Y, Sakamoto S. Surgery for atrial fibrillation: recent progress and future perspective. Gen Thorac Cardiovasc Surg. 2012;60:13–20.CrossRefPubMed
3.
Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–52.CrossRefPubMed
4.
Oi K, Arai H. Stroke associated with coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2015;63:487–95.CrossRefPubMed
5.
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107:2920–5.CrossRefPubMed
6.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.CrossRefPubMed
7.
Cox JL, Boineau JP, Schuessler RB, Ferguson TB Jr, Cain ME, Lindsay BD, et al. Successful surgical treatment of atrial fibrillation. Review and clinical update. JAMA. 1991;266:1976–80.CrossRefPubMed
8.
Cox JL, Schuessler RB, D’Agostino HJ Jr, Stone CM, Chang BC, Cain ME, et al. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg. 1991;101:569–83.PubMed
9.
Saint LL, Bailey MS, Prasad S, Guthrie TJ, Bell J, Moon MR, et al. Cox-Maze IV results for patients with lone atrial fibrillation vs. concomitant mitral disease. Ann Thorac Surg. 2012;93:789–94.CrossRefPubMedPubMedCentral
10.
Takahashi S, Sueda T. Development of the Maze procedure and the contribution of Japanese surgeons. Gen Thorac Cardiovasc Surg. 2017;65:144–52.CrossRefPubMed
11.
Gammie JS, Haddad M, Milford-Beland S, Welke KF, Ferguson TB Jr, O’Brien SM, et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg. 2008;85:909–14.CrossRefPubMed
12.
Kubota S, Sugiki H, Wakasa S, Ooka T, Tachibana T, Sasaki S, et al. Can we change the operative criteria for the MAZE procedure combined with valve surgery in the era of radiofrequency devices? Gen Thorac Cardiovasc Surg. 2011;59:406–12.CrossRefPubMed
13.
Lall SC, Melby SJ, Voeller RK, Zierer A, Bailey MS, Guthrie TJ, et al. The effect of ablation technology on surgical outcomes after the Cox-maze procedure: a propensity analysis. J Thorac Cardiovasc Surg. 2007;133:389–96.CrossRefPubMed
14.
Ad N, Cox JL. The Maze procedure for the treatment of atrial fibrillation: a minimally invasive approach. J Card Surg. 2004;19:196–200.CrossRefPubMed
15.
Robertson JO, Cuculich PS, Saint LL, Schuessler RB, Moon MR, Lawton J, et al. Predictors and risk of pacemaker implantation after the Cox-maze IV procedure. Ann Thorac Surg. 2013;95:2015–20.CrossRefPubMedPubMedCentral
16.
Worku B, Pak SW, Cheema F, Russo M, Housman B, Van Patten D, et al. Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation. Ann Thorac Surg. 2011;92:2085–9.CrossRefPubMed
17.
Gillinov AM, Bhavani S, Blackstone EH, Rajeswaran J, Svensson LG, Navia JL, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg. 2006;82:502–13.CrossRefPubMed
18.
Shimizu W, Kosakai Y, Inagaki M, Kurita T, Suyama K, Aihara N, et al. Electrophysiologic changes in arrhythmogenic substrate following the maze procedure in patients with lone and paroxysmal atrial fibrillation. Jpn Circ J. 1997;61:988–96.CrossRefPubMed
19.
Kamata J, Kawazoe K, Izumoto H, Kitahara H, Shiina Y, Sato Y, et al. Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. Ann Thorac Surg. 1997;64:394–8.CrossRefPubMed
20.
Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified Cox-maze procedure for elderly patients: a risk analysis for failure. Interact Cardiovasc Thorac Surg. 2011;12:924–8.CrossRefPubMed
21.
Fujita T, Kobayashi J, Toda K, Nakajima H, Iba Y, Shimahara Y, et al. Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation. J Thorac Cardiovasc Surg. 2010;140:1332–7.CrossRefPubMed
22.
Xi Q, Sahakian AV, Ng J, Swiryn S. Atrial fibrillatory wave characteristics on surface electrogram: ECG to ECG repeatability over twenty-four hours in clinically stable patients. J Cardiovasc Electrophysiol. 2004;15:911–7.CrossRefPubMed
23.
Nault I, Lellouche N, Matsuo S, Knecht S, Wright M, Lim KT, et al. Clinical value of fibrillatory wave amplitude on surface ECG in patients with persistent atrial fibrillation. J Interv Card Electrophysiol. 2009;26:11–9.CrossRefPubMed
24.
Nakagawa K, Hirai T, Shinokawa N, Uchiyama Y, Kameyama T, Takashima S, et al. Relation of fibrillatory wave amplitude with hemostatic abnormality and left atrial appendage dysfunction in patients with chronic nonrheumatic atrial fibrillation. Jpn Circ J. 2001;65:375–80.CrossRefPubMed
25.
Thurmann M, Janney JG Jr. The diagnostic importance of fibrillatory wave size. Circulation. 1962;25:991–4.CrossRefPubMed
26.
Morganroth J, Horowitz LN, Josephson ME, Kastor JA. Relationship of atrial fibrillatory wave amplitude to left atrial size and etiology of heart disease. An old generalization re-examined. Am Heart J. 1979;97:184–6.CrossRefPubMed
27.
Lie JT, Falk RH, James TN. Cardiac anatomy and pathologic correlates of atrial fibrillation. In: Falk RH, Podrid PJ, editors. Atrial fibrillation: mechanisms and management. 2nd ed. Philadelphia: Lippincott-Raven; 1997. pp. 23–52.
28.
Atarashi H, Fujiwara T, Saitoh H, Hayakawa H. Age-related decrease in amplitude of f wave in chronic atrial fibrillation (in Japanese). Nihon Ronen Igakkai Zasshi. 1987;24:11–5.CrossRefPubMed
29.
Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51:802–9.CrossRefPubMed
30.
Tan AY, Zhou S, Ogawa M, Song J, Chu M, Li H, et al. Neural mechanisms of paroxysmal atrial fibrillation and paroxysmal atrial tachycardia in ambulatory canines. Circulation. 2008;118:916–25.CrossRefPubMedPubMedCentral
31.
Xu Y, Sharma D, Li G, Liu Y. Atrial remodeling: new pathophysiological mechanism of atrial fibrillation. Med Hypotheses. 2013;80:53–6.CrossRefPubMed
32.
JCS Joint Working Group. Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013). Circ J. 2014;78:1997–2021.CrossRef
33.
Hirayama Y, Atarashi H, Kobayashi Y, Horie T, Iwasaki Y, Maruyama M, et al. Angiotensin-converting enzyme inhibitor therapy inhibits the progression from paroxysmal atrial fibrillation to chronic atrial fibrillation. Circ J. 2005;69:671–6.CrossRefPubMed
34.
Nakashima H, Kumagai K, Urata H, Gondo N, Ideishi M, Arakawa K. Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation. 2000;101:2612–7.CrossRefPubMed
35.
Kumagai K, Nakashima H, Urata H, Gondo N, Arakawa K, Saku K. Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol. 2003;41:2197–204.CrossRefPubMed
36.
Goette A, Arndt M, Röcken C, Spiess A, Staack T, Geller JC, et al. Regulation of angiotensin II receptor subtypes during atrial fibrillation in humans. Circulation. 2000;101:2678–81.CrossRefPubMed
37.
Dogan A, Akcay S, Karabacak M, Turker Y, Ozaydin M, Erdogan D. The effect of pretreatment with renin-angiotensin-aldosterone system blockers on cardioversion success and acute recurrence of atrial fibrillation. Int J Clin Pract. 2009;63:1017–23.CrossRefPubMed
Metadata
Title
Predictors of the need for pacemaker implantation after the Cox maze IV procedure for atrial fibrillation
Authors
Naoki Masaki
Shunsuke Kawamoto
Naotaka Motoyoshi
Osamu Adachi
Kiichiro Kumagai
Satoshi Kawatsu
Yukihiro Hayatsu
Shintaro Katahira
Katsuhiro Hosoyama
Masatoshi Akiyama
Yoshikatsu Saiki
Publication date
01-05-2018
Publisher
Springer Singapore
Published in
Surgery Today / Issue 5/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1614-7

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