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Philippe K.E.W. Ballaux
Karl M.E. Dossche
Aart Brutel de la Rivière
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J Thorac Cardiovasc Surg 2006;132:1433-1440
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Freedom from atrial arrhythmias after classic maze III surgery: A 10-year experience

Philippe K.E.W. Ballaux, MD, MSca,*, Guillaume S.C. Geuzebroek, MSa, Norbert M. van Hemel, MD, PhDb, Johannes C. Kelder, MD, PhDb, Karl M.E. Dossche, MD, PhDa, Jef M.P.G. Ernst, MDb, Lukas V.A. Boersma, MD, PhDb, Eric F.D. Wever, MDb, Aart Brutel de la Rivière, MD, PhDa, Jo J.A.M.T. Defauw, MDa

a Heart Lung Center Utrecht, Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
b Heart Lung Center Utrecht, Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.

* Address for reprints: Philippe K. E. W. Ballaux, MD, Department of Cardiac Surgery, Maria Middelares Hospital, Kortijksesteenweg 1026, B-9000 Gent, Belgium. (Email: phballaux{at}yahoo.com).

OBJECTIVES: We studied the persistence of favorable outcome, the occurrence of new atrial arrhythmias, and sinus node dysfunction in patients who underwent the maze III procedure.

METHODS: Preoperative, in-hospital, and follow-up data of 203 patients who underwent the maze III procedure between June 1993 and June 2003 were collected. A total of 139 patients underwent the maze procedure for lone atrial fibrillation, and 64 patients underwent the maze procedure and concomitant cardiac surgery.

RESULTS: There was no 30-day postoperative mortality. During a mean follow-up of 4.0 ± 2.6 years, 12 patients (6%) died (2 cardiac related). At the end of follow-up, freedom from supraventricular arrhythmias was 80% for the lone atrial fibrillation group and 64% for the concomitant atrial fibrillation group. Freedom from stroke during follow-up was 100% in the lone atrial fibrillation group and 97% in the concomitant group. Multivariate analysis revealed that rhythm at 1-year follow-up (P < .001; odds ratio 9.56, 95% confidence limits 3.92-23.31) and preoperative left atrium dimension (P = .028; odds ratio 1.06 for every millimeter, 95% confidence limits 1.01-1.12) were predictors of success at the end of follow-up.

CONCLUSIONS: This study shows that the favorable results of the maze III procedure in terms of freedom from supraventricular arrhythmias persist in most patients for at least 4 years.

Abbreviations and Acronyms AF = atrial fibrillation; AFL = atrial flutter; AV = atrioventricular; CAF = chronic atrial fibrillation; CL = confidence limit; CVA = cerebrovascular accident; LA = left atrial; OR = odds ratio; PAF = paroxysmal atrial fibrillation; RA = right atrial


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