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(Circulation. 2000;101:1559.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation

Emile R. Jessurun, MD; Norbert M. van Hemel, MD; Jo A. M. T. Defauw, MD; Monique A. M. Stofmeel, MD; Johannes C. Kelder, MD; Aart Brutel de la Rivière, MD; Jef M. P. G. Ernst, MD

From the Departments of Cardiology (E.R.J, N.M.v.H., M.A.M.S., J.C.K., J.M.P.G.E.) and Cardiothoracic Surgery (J.A.M.T.D., A.B.d.l.R.), St Antonius Hospital, Nieuwegein, The Netherlands.

Correspondence to N.M. van Hemel, MD, Department of Cardiology, St Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands. E-mail rdcardio{at}worldonline.nl

Background—If drug refractoriness to paroxysmal atrial fibrillation (PAF) occurs, arrhythmia surgery that involves channelling and the exclusion of specific atrial areas can abolish atrial fibrillation. The purpose of this study was to establish the effectiveness and safety of maze III surgery to abolish PAF.

Methods and Results—Surgery was performed in 41 selected patients who had long-standing, symptomatic, drug-refractory, lone PAF. At discharge, 35 patients (85%) were arrhythmia free, and 6 patients (15%) showed PAF and paroxysmal atrial tachycardia. Death or stroke did not occur during a mean follow-up of 31±16 months. At the end of follow-up, 39 patients (95%) had no PAF; however, in 2 patients (5%), PAF persisted and eventually required His bundle ablation and pacing. Three months after surgery, nodal escape rhythm was observed in only 1 patient, whereas sick-sinus syndrome emerged late after surgery in 2 patients. Antiarrhythmic drugs were used in 20% of patients during follow-up. The quality of life improved markedly after surgery and remained unchanged afterward. Echocardiographic findings did not alter, but exercise capacity increased.

Conclusions—This pilot study demonstrates the effectiveness and safety of maze III surgery for lone PAF. In patients without sick-sinus syndrome, this intervention offers a sensible alternative to His bundle ablation and lifelong pacemaker dependency.

Key Words: atrial fibrillation • surgery • arrhythmia

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