Incidence of and Risk Factors for Pacemaker Implantation After the Modified Cryo-Maze Procedure for Atrial Fibrillation

2021 ◽  
Author(s):  
Takashi Kakuta ◽  
Satsuki Fukushima ◽  
Kimito Minami ◽  
Naonori Kawamoto ◽  
Naoki Tadokoro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Maze Procedure

scholarly journals The occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xue Wang ◽  
Heng Gao ◽  
Chao Deng ◽  
Miaomiao Liu ◽  
Yang Yan
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Tricuspid Regurgitation ◽  
Sinus Bradycardia ◽  
Cardiac Surgical Procedures ◽  
Maze Procedure ◽  
Multivariate Logistic Regression Model ◽  
Severe Tricuspid Regurgitation ◽  
Medical College ◽  
Area Under Roc Curve

Abstract Objective To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation. Methods All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model. Results We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127–1.874), area under ROC curve was 0.81, the Jordan index was 0.665. Conclusion The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.

P6557Permanent atrial fibrillation development in patients with DDD pacemaker -Rrisk factors and association with mortality in long-term

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Debski ◽  
M Ulman ◽  
A Zabek ◽  
K Boczar ◽  
K Haberka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Hospital Discharge ◽  
Pacemaker Implantation ◽  
Cox Proportional Hazards Model ◽  
Registration System ◽  
All Cause Mortality ◽  
Lost To Follow Up

Abstract Background In patients undergoing permanent DDD cardiac pacing, the maintenance of atrial contractility is important to ensure adequate ventricular filling and to guarantee an optimal ventricular ejection capacity. Atrial fibrillation (AF) is a major risk factor for thromboembolic events and is associated with increased cardiovascular and all-cause mortality. Purpose To analyse the risk factors for development of permanent AF in patients with DDD pacemaker and determine its association with all-cause mortality in long-term follow-up. Methods Retrospectively collected records comprised all consecutive patients who underwent primary DDD pacemaker implantation at single-centre between 1984–2014. Patients who were lost to follow-up after hospital discharge were excluded from analysis. Follow-up was completed on 31st August 2016. Definition of permanent AF was the occurence of AF which persisted until the end of follow-up. Data on patients' survival status and deceased patients' dates of death were collected from the national death registration system. Information of death date was available as of 31st August 2016. The endpoint was all-cause mortality. Results We included a total of 3771 patients and 24,432 patient-years of follow-up and exluded 157 (4%) patients who were lost to follow-up after hospital discharge. Mean follow-up was 78±62 months (max. 370 months), 1761 (47%) were female. Paroxysmal AF prior to DDD pacemaker implantation was detected in 1276 patients (34%). During entire follow-up 717 (19%) patients developed permanent AF in a mean period of 55±50 months. Analysis of risk factors for development of permanent AF is presented in Figure. Cox proportional hazards model with time-dependent covariate showed that development of permanent AF significantly increased mortality during follow-up (HR = 1.885, 95% CI, 1.654–2.148, P<0.001; with adjustment for age at implantation and sex: HR = 1.475, 95% CI, 1.294–1.682, P<0.001). Permanent AF risk factors Conclusions Female sex protected against permanent AF development, whereas age at implantation, history of paroxysmal AF and apical position of RV lead increased the risk. Permanent AF was significantly increasing the all-cause mortality, even after adjustment for age at implant and gender. Acknowledgement/Funding None

scholarly journals Surgical Treatment of Concomitant Atrial Fibrillation: Focus onto Atrial Contractility

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Claudia Galli ◽  
Moreno Naliato ◽  
Fabrizio Veglia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Right Atrial ◽  
Lv Function ◽  
Factors Associated ◽  
Procedural Success ◽  
Cox Analysis

Background. Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation.Methods. 122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied.Results. At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes.Conclusions. SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia “chronic state” (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and “kick” restoring and an influence of RA contraction onto LV function.

scholarly journals Predictor of Atrial Fibrillation Recurrence in Patients who Underwent a Tricuspid Valve Operation with Modified Cox Maze procedure

2021 ◽  
Author(s):  
Minjung Bak ◽  
Sung-Ji Park ◽  
Dong Seop Jeong ◽  
Boram Park ◽  
Jeong Hun Seo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Tricuspid Valve ◽  
Total Mortality ◽  
Maze Procedure ◽  
P Value ◽  
Surgical Ablation ◽  
Significant Difference ◽  
Recurrence Group ◽  
Af Recurrence

Abstract Background Recurrence of any atrial arrhythmia after surgical ablation is known as a negative predictor of cardiovascular events and total mortality. However, there have been no focused studies for atrial fibrillation (AF) recurrence prediction in patients with significant tricuspid regurgitation (TR), and the risk-benefit estimation of surgical ablation in tricuspid valve (TV) surgery is not fully established. Objectives In this study, we analyzed predictors of AF recurrence, safety, and efficacy of the modified Cox maze (CM) procedure in patients with AF undergoing TV operation.Method We screened 421 patients who underwent a TV operation between 1994 and 2017. After excluding patients who did not undergo a maze operation, 158 patients were enrolled. Enrolled patients were divided by recurrence of AF.We analyzed the difference between the AF recurrence group and no AF recurrence group, and AF recurrence factors in terms of clinical risk factors and echocardiographic risk factors. The hazard ratio (HR) and 95% confidence intervals (CIs) were presented using a Cox proportional hazard model.ResultS Among 158 patients, AF recurred in 65 patients within 10 years. For AF prediction, age was most the important clinical factor and right atrium (RA) diameter was the most important echocardiographic parameters. In patients with a larger RA diameter over 49.2mm, the prevalence of AF recurrence was higher (HR 4.322, 95% CI [2.185-8.549], log rank p value < 0.001). In clinical outcome, there was no significant difference between the AF recurrence group and the no recurrence group in terms of death, TR recurrence, heart failure and stroke. However, the risk of permanent pacemaker (PPM) insertion was higher in the AF recurrence group (HR 4.706, 95% CI [0.975-22.708], log rank p value 0.034) compared to the no recurrence group. Conclusion Age and RA enlargement are key predictors of AF recurrence after TV operation with the CM procedure in patients with significant TR.

scholarly journals Risk Factors for Bradycardia Requiring Pacemaker Implantation in Patients With Atrial Fibrillation

2012 ◽  
Vol 110 (9) ◽  
pp. 1315-1321 ◽  
Author(s):  
Tyler W. Barrett ◽  
Robert L. Abraham ◽  
Cathy A. Jenkins ◽  
Stephan Russ ◽  
Alan B. Storrow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Pacemaker Implantation

scholarly journals A single center's experience with pacemaker implantation after the Cox maze procedure for atrial fibrillation

2017 ◽  
Vol 154 (1) ◽  
pp. 139-146.e1 ◽  
Author(s):  
Niv Ad ◽  
Sari D. Holmes ◽  
Rabia Ali ◽  
Graciela Pritchard ◽  
Deborah Lamont
Keyword(s):  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Maze Procedure

scholarly journals Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation

2016 ◽  
Vol 40 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Ru-Xing Wang ◽  
Hon-Chi Lee ◽  
Jia-Ping Li ◽  
David O. Hodge ◽  
Yong-Mei Cha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sudden Death ◽  
Pacemaker Implantation ◽  
Atrioventricular Junction

scholarly journals Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillation

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001125
Author(s):  
Frederik Dalgaard ◽  
Jannik Langtved Pallisgaard ◽  
Tommi Bo Lindhardt ◽  
Gunnar Gislason ◽  
Paul Blanche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Risk Score ◽  
Proportional Hazards ◽  
Predictive Accuracy ◽  
Pacemaker Implantation ◽  
Cox Proportional Hazards ◽  
Newly Diagnosed ◽  
Predictive Risk

ObjectivesTo identify risk factors and to develop a predictive risk score for pacemaker implantation in patients with atrial fibrillation (AF).MethodsUsing Danish nationwide registries, patients with newly diagnosed AF from 2000 to 2014 were identified. Cox proportional-hazards regression computed HRs for risk factors of pacemaker implantation. A logistic regression was used to fit a prediction model for 3-month risk of pacemaker implantation and derived a risk score using 80% of the data and its predictive accuracy estimated using the remaining 20%.ResultsAmong 155 934 AF patients included, the median age (IQR) was 75 (65–83) and 51.3% were men. During a median follow-up time of 3.4 (1.2–5.0) years, 8348 (5.4%) patients received a pacemaker implantation. Risk factors of pacemaker implantation were (in order of highest risk first) age above 60 years, congenital heart disease, heart failure at age under 60 years, prior syncope, valvular AF, hypertension, ischaemic heart disease, male sex and diabetes mellitus. The derived risk score assigns points ranging from 1 to 14 to each of these risk factors. The 3-month risk of pacemaker implantation increased from 0.4% (95% CI: 0.2 to 0.8) at 1 point to 2.6% (95% CI: 1.9 to 3.6) at 18 points. Area under the receiver operator characteristics curve was 62.9 (95% CI: 60.3 to 65.5).ConclusionWe highlighted risk factors of pacemaker implantation in newly diagnosed AF patients and created a risk score. The clinical utility of the risk score needs further investigation.

Abstract 11867: Late Stroke Rates After Maze Procedure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroshi Tsuneyoshi ◽  
Tatsuhiko Komiya ◽  
Takeshi Shimamoto
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiovascular Surgery ◽  
Maze Procedure ◽  
Hemorrhagic Events ◽  
The Mean

Introduction: Late stroke can affect quality of life after cardiac surgery. Atrial fibrillation is the most common cardiac arrhythmia and raises the risk of stroke; however, the incidence of late stroke after the Maze procedure has not been determined. Methods: We conducted a retrospective review of 4021 patients who underwent cardiac surgery at our institution between 2000 and 2013. Results: Follow-up data were obtained from 88% of patients at a mean of 4.8±3.4 years. Among these patients, 2.4% (95/4021) experienced symptomatic late stroke (mean period after surgery was 55±35 months, and the mean age was 72±13 years). About 32% (30/95) of patient strokes were caused from atrial fibrillation, 2% (2/95) from hemorrhagic events, 3% (3/95) from cerebral artery diseases, and 63% (60/95) from unknown causes. Among 345 of the 4021 patients who underwent the Maze procedure (Full Maze: 157, LA Maze: 132, PV isolation: 56), 70.5% have remained in sinus rhythm as of their last follow-up. Just 4.3% (15/345) of patients that underwent the Maze procedure had a late stroke during the follow-up period. Of the 15 patients who had a late stroke, 10 failed the Maze procedure and remained in atrial fibrillation. In 60% (9/15) of patients experiencing a late stroke after the Maze procedure, the LA appendage was not closed at the time of surgery. Conclusions: The cause of late stroke after cardiovascular surgery was atrial fibrillation in not less than 30% of patients. The incidence of late stroke after the Maze procedure was 4.3%, which was relatively low considering these patients had arrhythmia problems before the operation (2.4% of all cardiac patients experienced a late stroke). Unsuccessful cases of the Maze procedure and non-LA appendage closure were considered risk factors for late stroke. When patients have atrial fibrillation prior to surgery, we recommend a concomitant Maze procedure or at least LA appendage closure to reduce the incidence of late stroke.

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