Atrial fibrillation: Maze surgery seemed effective.

Clinical bottom line (level 4)

  1. Over 90% of patients with atrial fibrillation or flutter who received the Maze operation were free of arrhythmias for up to 8 years.
  2. 2% died during surgery, and less than 1% required a permanent pacemaker.
Cox et al: Annals of Surgery 1996; 324 (3): 267-275
Expires November 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: two cardiothoracic units, USA

178 patients (aged range 22 to 77 years; mean 54, 74% male) paroxysmal or chronic atrial fibrillation or flutter who underwent the Maze procedure (atriotomy to control arrhythmias)
Spironolactone was given prophylactically and aggressive diuretics given to treat post-operative fluid retention. Anticoagulation not routinely given (unless history of thromboembolism when it was given 6-18 weeks).

92% followed for 3 months to 8.5 years
Outcomes studied:
  • perioperative mortality at 3 months
  • permanent pacemaker
  • recurrent arrhythmia

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    perioperative mortality 3 months to 8.5 years 4/178 2.2%
    (0.07% to 4.4%)
    permanent pacemaker 3 months to 8.5 years 1/164 0.61%
    (0.0% to 1.8%)
    recurrent arrhythmia 3 months to 8.5 years 12/164 7.3%
    (3.3% to 11%)

    Comments

    1. Patient details were not included, including echocardiography, state of coronary vessels, previous morbidity, medications, symptom severity in order to obtain accurate information about prognosis. Three operations performed. No details on average follow-up period.
    2. Need a randomised controlled trial comparing this with standard medical therapy.

    Citation

    1. Cox JL, Schuessler RB, Lappas DG, et al: An 8½- year clinical experience with surgery for atrial fibrillation. Annals of Surgery 1996; 324 (3): 267-275
    Contributor: Nick Shenker and Chris Ball, November 2000
    Reviewer:

    Clinical Question.
    Patient AF
    Intervention or Exposure Maze operation
    Outcome free from arrhythmias