Surgical ablation for atrial fibrillation is efficacious in patients with giant left atria
MMO McGilvray, NH Bakir, TAE Yates, MO Kelly… - The Journal of Thoracic …, 2024 - Elsevier
The Journal of Thoracic and Cardiovascular Surgery, 2024•Elsevier
Abstract Objective The Cox-Maze IV procedure (CMP-IV) is the most effective treatment for
atrial fibrillation. Increased left atrial (LA) size has been identified as a risk factor for failure to
restore sinus rhythm. This has biased many surgeons against ablation in patients with giant
left atrium (GLA), defined as LA diameter> 6.5 cm. In this study we aimed to define the
efficacy of the CMP-IV in patients with GLA. Methods From April 2004 through March 2020,
786 patients with a documented LA diameter underwent elective CMP-IV, 72 of whom had …
atrial fibrillation. Increased left atrial (LA) size has been identified as a risk factor for failure to
restore sinus rhythm. This has biased many surgeons against ablation in patients with giant
left atrium (GLA), defined as LA diameter> 6.5 cm. In this study we aimed to define the
efficacy of the CMP-IV in patients with GLA. Methods From April 2004 through March 2020,
786 patients with a documented LA diameter underwent elective CMP-IV, 72 of whom had …
Objective
The Cox-Maze IV procedure (CMP-IV) is the most effective treatment for atrial fibrillation. Increased left atrial (LA) size has been identified as a risk factor for failure to restore sinus rhythm. This has biased many surgeons against ablation in patients with giant left atrium (GLA), defined as LA diameter >6.5 cm. In this study we aimed to define the efficacy of the CMP-IV in patients with GLA.
Methods
From April 2004 through March 2020, 786 patients with a documented LA diameter underwent elective CMP-IV, 72 of whom had GLA. Median follow-up duration was 4 years (interquartile range, 1-7 years). Recurrence was defined as any documented atrial tachyarrhythmia (ATA) lasting 30 seconds. ATA recurrence and survival were analyzed across GLA versus non-GLA groups.
Results
Median age at surgery was 65 (interquartile range, 56-73) years. Median LA diameter within the GLA group was 7.0 (range, 6.6-10.0) cm. There were no differences in rates of postoperative complications for the 2 groups, including rate of postoperative stroke and pacemaker placement (GLA 14%; non-GLA 12%; P = .682). A trend toward increased 30-day mortality in the GLA group did not reach statistical significance (GLA 6%; non-GLA 2%; P = .051). Freedom from ATAs at 5 years postoperatively was comparable for the 2 groups (GLA 82%; non-GLA 84%).
Conclusions
The CMP-IV had good efficacy in patients with GLA. Our results suggest that LA diameter >6.5 cm should not preclude a patient from undergoing surgical ablation for atrial fibrillation.
Elsevier
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