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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 Dicembre;40(6):793-6

lingua: Inglese

What are the pre­dic­tors of res­to­ra­tion of ­sinus ­rhythm ­after com­bined treat­ment with sur­gi­cal ­repair for organ­ic ­heart dis­ease and the ­Maze pro­ce­dure for atri­al fib­ril­la­tion?

Ueshima K., Hashimoto K., Chiba M., Nakamura M., Nasu M., Hiramori K., Kamata J.*, Yagi Y.*, Kawazoe K.*

From the Second Department of Internal Medicine and the *Third Department of Surgery Iwate Medical University, Morioka, Japan


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Background. Recently, com­bined treat­ment ­using the Maze pro­ce­dure for organ­ic ­heart dis­ease and atri­al fib­ril­la­tion has ­been report­ed, but ­there ­have ­been few stud­ies of car­diac ­rhythm ­after com­bined treat­ment. Predictors of car­diac ­rhythm ­after com­bined sur­gi­cal treat­ment ­have ­been ­unknown.
Methods. Thirty ­patients who under­went car­diac sur­gery ­with the Maze pro­ce­dure ­were ret­ro­spec­tive­ly ­enrolled in ­this ­study. Two ­groups con­sist­ed of the ­patients ­with res­to­ra­tion of ­sinus ­rhythm ­after sur­gery (SR: n=15, 6 ­males and 9 ­females, ­mean age of 64 ­years), and the ­patients ­with main­te­nance of atri­al fib­ril­la­tion (AF; n=15, 5 ­males and 10 ­females, ­mean age of 61 ­years). Before car­diac sur­gery, all ­patients under­went exer­cise test­ing ­with meas­ure­ment of atri­al nat­riu­ret­ic pep­tide (ANP) ­before and ­after exer­cise test­ing, two-dimen­sion­al ech­o­car­di­og­ra­phy, and ­right and ­left ­heart cath­et­er­iza­tion.
Results. The ­mean max­i­mal ­heart ­rate and the ANP lev­el ­after exer­cise test­ing in SR ­were sig­nif­i­cant­ly high­er ­than ­those in AF. The ­left atri­al dimen­sion and ­right atri­al and pul­mo­nary cap­il­lary ­wedge pres­sures ­were sig­nif­i­cant­ly high­er in AF ­than in SR. These find­ings indi­cate ­that sub­jects in SR exhib­it­ed ­less ­impaired atri­al func­tion ­which were eval­u­at­ed by exer­cise test­ing ­with meas­ure­ment of ANP, ech­o­car­di­og­ra­phy, and car­diac cath­et­er­iza­tion.
Conclusions. The atri­al func­tion of ­patients ­with ­sinus ­rhythm ­after the Maze pro­ce­dure may be ­less ­impaired ­than ­that of ­patients remain­ing in atri­al fib­ril­la­tion.

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