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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

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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