(Circulation. 1995;91:2392-2399.)
© 1995 American Heart Association, Inc.
Articles |
Delayed Improvement in Exercise Capacity With Restoration of Sinoatrial Node Response in Patients After Combined Treatment With Surgical Repair for Organic Heart Disease and the Maze Procedure for Atrial Fibrillation
From the Division of Cardiology, Department of Medicine (J.T., T.Y., H.T., Y.O.), Department of Cardiovascular Surgery (Y. Kosakai, Y. Kawashima), and Laboratory of Clinical Physiology (E.O.), National Cardiovascular Center, Suita, Osaka, Japan.
Correspondence to Jun Tamai, MD, Division of Cardiology, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565, Japan.
Background Although the Maze procedure successfully restores sinus rhythm in patients with heart disease and atrial fibrillation, it is still uncertain whether an addition of the Maze procedure in cardiac surgery is beneficial for exercise performance of the patients after surgery.
Methods and Results The Maze procedure was performed in 25
patients (age, 37 to 70 years) during valve surgery (18 patients) or
closure of atrial septal defect (7 patients). A cardiopulmonary
exercise test using ramp incremental protocol (15 W/min) was performed
before and 1 month, 6 months, and 1 year after surgery. Sinus
conversion was obtained in 23 of 25 patients 1 month after surgery.
However, sinoatrial (SA) node response to exercise was attenuated by
surgery: Mean heart rate (HR) was 83±13/min at rest, 94±13/min
at 60
W, and 107±17/min at peak exercise. Peak oxygen uptake
(P
2) was unchanged at this
period (before, 17.6±4.5
mL · min-1 · kg-1; 1 month
after,
17.5±4.2
mL · min-1 · kg-1).
Thereafter, SA node response was restored 6 months after surgery: Mean
HR was 84±13/min at rest, 104±16/min at 60 W, and
130±20/min at peak
exercise (P<.01 versus 1 month).
P2 was also improved at
this
period (20.7±4.0
mL · min-1 · kg-1,
P<.01). The increase in
P2 from 1 month to 6 months
after surgery was correlated with the increase in peak HR
(y=0.73x±3.6, r=.79). There
were no further changes in heart rate response or
P2 from 6 months to 1 year
after surgery.
Conclusions Atrial fibrillation was successfully treated by combined treatment with surgical repair for organic heart disease and the Maze procedure. However, SA node response to exercise was attenuated early after surgery. Thus, exercise capacity was improved at the late phase after surgery, which was related to the extent of restoration in SA node response.
Key Words: exercise • surgery • fibrillation • heart diseases
This article has been cited by other articles:
 |
|
 |
|
  M. Mabuchi, M. Imamura, N. Kubo, K. Morita, K. Noriyasu, T. Tsukamoto, K. Yasuda, and N. Tamaki Sympathetic Denervation and Reinnervation After the Maze Procedure J. Nucl. Med., July 1, 2005; 46(7): 1089 - 1094. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Yuda, S Nakatani, Y Kosakai, T Satoh, Y Goto, M Yamagishi, K Bando, S Kitamura, and K Miyatake Mechanism of improvement in exercise capacity after the maze procedure combined with mitral valve surgery Heart, January 1, 2004; 90(1): 64 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Iwase, N Nagaya, M Ando, T Satoh, F Sakamaki, S Kyotani, H Takaki, Y Goto, Y Ohkita, M Uematsu, et al. Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension Heart, August 1, 2001; 86(2): 188 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Everett IV, J. R. Moorman, L.-C. Kok, J. G. Akar, and D. E. Haines Assessment of Global Atrial Fibrillation Organization to Optimize Timing of Atrial Defibrillation Circulation, June 12, 2001; 103(23): 2857 - 2861. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Le Tourneau, P. de Groote, A. Millaire, C. Foucher, C. Savoye, P. Pigny, A. Prat, H. Warembourg, and J. M. Lablanche Effect of mitral valve surgery on exercise capacity, ventricular ejection fraction and neurohormonal activation in patients with severe mitral regurgitation J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2263 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Jessurun, N. M. van Hemel, J. A. M. T. Defauw, M. A. M. Stofmeel, J. C. Kelder, A. Brutel de la Riviere, and J. M. P. G. Ernst Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation Circulation, April 4, 2000; 101(13): 1559 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. MIYAMOTO, N. NAGAYA, T. SATOH, S. KYOTANI, F. SAKAMAKI, M. FUJITA, N. NAKANISHI, and K. MIYATAKE Clinical Correlates and Prognostic Significance of Six-minute Walk Test in Patients with Primary Pulmonary Hypertension . Comparison with Cardiopulmonary Exercise Testing Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 487 - 492. [Abstract] [Full Text]
|
|
|
|
 |
|
 P.R. Vogt, H.P. Brunner-LaRocca, M. Rist, G. Zund, M. Genoni, M. Lachat, U. Niederhauser, and M.I. Turina Preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction Eur. J. Cardiothorac. Surg., June 1, 1999; 13(6): 619 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Mitchell, I. D. McRury, and D. E. Haines Linear Atrial Ablations in a Canine Model of Chronic Atrial Fibrillation : Morphological and Electrophysiological Observations Circulation, March 31, 1998; 97(12): 1176 - 1185. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Fukushima, T. Emori, W. Shimizu, T. Kurita, N. Aihara, Y. Kosakai, F. Isobe, K. Shimomura, Y. Kawashima, and T. Ohe Delayed improvement of autonomic nervous abnormality after the Maze procedure: time and frequency domain analysis of heart rate variability using 24 hour Holter monitoring Heart, November 1, 1997; 78(5): 499 - 504. [Abstract] [Full Text] [PDF]
|
|