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J Thorac Cardiovasc Surg 2007;134:448-453
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Preoperative left atrial volume index is a predictor of successful sinus rhythm restoration and maintenance after the maze operation

^a Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea
^b Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Received for publication May 18, 2006; revisions received January 26, 2007; accepted for publication February 5, 2007.

^_* Address for reprints: Sang-Chol Lee, MD, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. (Email: sclee{at}med.skku.ac.kr).

Objective: The purpose of this study was to identify the relationship of preoperative and postoperative left atrial volume indices and dimensions with successful restoration of sinus rhythm after the maze operation.

Methods: Forty-three patients who underwent the Cox-maze III procedure for permanent atrial fibrillation in conjunction with surgical intervention for various heart diseases were evaluated. Echocardiographic studies were performed preoperatively and 3 months postoperatively. Volumes and dimensions were corrected for body surface area and analyzed.

Results: Sinus rhythm was restored and maintained in 36 (83.7%) of the 43 patients. The preoperative left atrial volume index of the group with successful restoration of sinus rhythm (group A) was significantly smaller than that of the group with unsuccessful restoration (group B: 76.7 ± 16.4 vs 108.9 ± 43.9 mL/m², P = .047). In group A the volume index (76.7 ± 16.4 vs 52.3 ± 15.0 mL/m², P < .001) and dimension index (35.8 ± 6.2 vs 30.8 ± 4.7 mL/m², P < .001) decreased significantly 3 months after the operation. No such significant changes were found in group B. The duration of arrhythmia for group A was significantly shorter than that for group B (3.4 ± 2.8 vs 13.7 ± 8 years, P = .001).

Conclusions: The preoperative left atrial volume index, as opposed to the conventional left atrial dimension, and the duration of arrhythmia are important predictors of successful sinus rhythm restoration after the maze operation. A significant reduction of the volume index can be achieved in patients whose rhythm is successfully restored and maintained after the procedure.

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