Predictors of atrial fibrillation recurrence after simultaneous Maze-V procedure and coronary artery bypass grafting

Aim. To identify the predictors of atrial fibrillation (AF) recurrence after simultaneous Maze V procedure in combination with coronary artery bypass grafting.

Methods. Medical records of 102 patients with coronary artery disease and concomitant AF were retrospectively reviewed. All patients underwent coronary artery bypass grafting and the combined Maze V procedure. The patients were divided into 2 groups: 51 patients with paroxysmal AF (group I), and 51 patients with non-paroxysmal AF (group II). In group I, 6 cases of AF recurrence were detected (subgroup IA), while 45 patients (subgroup IB) maintained sinus rhythm for the entire follow-up period. Accordingly, in group II, the return of AF was noted in 9 patients (subgroup IIA), sinus rhythm - in 42 patients (subgroup IIB). The follow-up period was 36 months. Clinical and echocardiographic parameters were studied as predictors of AF recurrence.

Results. A significant predictor in patients with paroxysmal AF was a recurrence of AF at the hospital stage (odd ratio (OR) 10,25; 95% confidence interval (CI) 1,53-68,20; р=0.032). The duration of the AF history was the main predictor in patients with non-paroxysmal AF (OR 8,8; 95% CI 1,01-76,1; р=0.04). ROC analysis revealed a significant effect on the AF recurrence of left atrium (LA) dimension >48.5 mm, LA volume index >44.4 ml/m² for patients with paroxysmal AF, and left ventriclular end-diastolic volume > 150 ml for patients with non-paroxysmal AF

Conclusion. A recurrence of AF at the hospital stage, LA dimension, LA volume index were significant predictors of AF recurrence after coronary artery bypass grafting + Maze V procedure in patients with paroxysmal AF. А long AF history and left ventriclular end-diastolic volume played the role of predictors for patients with non-paroxysmal AF.

1. Popova N.V., Popov V.A., Revishvili A.Sh. Myocardial revascularization in chronic coronary artery disease. State of art. Kardiologiia. 2023;63(6): 3-13.(In Russ.) https://doi.org/10.18087/cardio.2023.6.n2263

2. Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 2018;155(1): 159-170. https://doi:10.1016/j.jtcvs.2017.09.095.

3. Schill M., Musharbash F, Hansalia V, et al. Late results of the Coxmaze IV procedure in patients undergoing coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2017;153(5): 1087-1094. https://doi.org/10.1016/j.jtcvs.2016.12.034.

4. Ad N, Suri R, Gammie JS, et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. The Journal of Thoracic and Cardiovascular Surgery. 2012;144: 1051-1060. https://doi.org/10.1016/j.jtcvs.2012.07.065

5. Revishvili AS, Popov VA, Aminov VV, et al. Surgical treatment of paroxysmal atrial fibrillation concomitant to coronary artery bypass grafting: pulmonary vein isolation or maze V? Complex Issues of Cardiovascular Diseases. 2022;11(4): 47-61. (In Russ.) https://doi.org/10.17802/2306-1278-2022-11-4-47-61

6. Revishvili AS, Popov VA, Malyshenko ES, et al. Surgical Treatment of Atrial Fibrillation Concomitant to Coronary Artery Bypass Grafting: In-Hospital and Long-Term Results of Maze V Procedure. Minimally Invasive Cardiovascular Surgery. 2022;(1): 43-55. (In Russ.)

7. Khiabani AJ, MacGregor RM, Bakir NH et al. The longterm outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery. 2022;163(2): 629-641.e7. https://doi.org/10.1016/j.jtcvs.2020.04.100.

8. Calkins H, Kuck KH, Cappato R et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm. 2012;9: 632-696. https://doi.org/10.1007/s10840-012-9672-7.

9. Osmancik P, Budera P, Straka Z et al. Predictors of complete arrhythmia free survival in patients undergoing surgical ablation for atrial fibrillation. PRAGUE-12 randomized study sub-analysis. International Journal of Cardiology. 2014;172: 419-22. https://doi.org/10.1016/j.ijcard.2014.01.104.

10. Gu W, Guo H, Lu C et al. Surgical ablation for persistent atrial fibrillation in concomitant cardiac surgery: mid-long-term result. European Journal of Cardio-Thoracic Surgery. 2017;52(5): 888-894. https://doi.org/10.1093/ejcts/ezx179.

11. Kornelyuk O.M., Mrochek A.G. Predictors of recurrence of atrial fibrillation after radiofrequency ablation of pulmonary veins. Medical news. 2016;9(264): 1-4 (In Russ.)

12. An K, Zhu J, Ma N et al. Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2-year follow-up. Clinical Cardiology. 2018;41: 372-377. https://doi.org/10.1002/clc.22878

13. McGilvray MMO, Bakir NH, Kelly MO et al. Efficacy of the stand-alone Cox-Maze IV procedure in patients with longstanding persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2021;32(10): 2884-2894. https://doi.org/10.1111/jce.15113.

14. Peng Z, Wen-Heng L, Qing Z et al. Risk factors for late recurrence in patients with nonvalvular atrial fibrillation after radiofrequency catheter ablation. Annals of Noninvasive Electrocardiology. 2022;27(2): e12924. https://doi.org/10.1111/anec.12924.

15. Hu QM, Li Y, Xu CL et al. Analysis of risk factors for recurrence after video-assisted pulmonary vein isolation of lone atrial fibrillation--results of 5 years of follow-up. The Journal of Thoracic and Cardiovascular Surgery. 2014;148(5): 2174-2180. https://doi.org/10.1016/j.jtcvs.2013.10.054.

16. Takagaki M, Yamaguchi H, Ikeda N et al. Risk factors for atrial fibrillation recurrence post Cox-maze IV performed without pre-exclusion, The Annals of Thoracic Surgery.2020;109(3): 771-779. https://doi.org/10.1016/j.athoracsur.2019.07.016

17. Kranert M, Shchetynska-Marinova T, Liebe V et al. Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index. In Vivo. 2020;34(2): 889-896. https://doi.org/10.21873/invivo.11854.

18. Njoku A, Kannabhiran M, Arora R et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A metaanalysis. Europace. 2018;20(1): 33-42. https://doi.org/10.1093/europace/eux013

19. Zhuang J, Wang Y, Tang K et al. Asociation between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: A systematic review and meta-analysis of observational studies. Europace. 2012;14(5): 638-645, https://doi.org/10.1093/europace/eur364

20. Jaïs P, Peng JT, Shah DC et al. Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2000;11: 623-625. https://doi.org/10.1111/j.1540-8167.2000.tb00023.x.

21. Dodson JA, Neilan TG, Shah RV, et al. Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation recurrence after pulmonary vein isolation. Circulation Cardiovascular Imaging. 2014;7: 586-592. https://doi.org/10.1161/CIRCIMAGING.113.001472

22. Lizewska-Springer A, Dabrowska-Kugacka A, Lewicka E et al. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiology Journal. 2018;27(6): 848-856. https://doi.org/10.5603/CJ.a2018.0067

23. Nedios S, Koutalas E, Sommer P, et al. Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes. Europace. 2017;19(9): 1463-1469. https://doi.org/10.1093/europace/euw225.

24. Seko Y, Kato T, Haruna T, et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Science Reports. 2018;8(1): 63-66. https://doi.org/10.1038/s41598-018-24875-1.

25. Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018;20(1): 33-42. https://doi:10.1093/europace/eux013.

26. Kornej J, Börschel CS, Benjamin EJ, et al. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circulation Research. 2020;127(1): 4-20. https://doi.org/10.1161/CIRCRESAHA.120.316340.