Left Versus Bi-Atrial Intraoperative Saline-Irrigated Radiofrequency Modified Maze Procedure for Atrial Fibrillation

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Abstract
Background: This study was conducted to evaluate the effectiveness of the saline-irrigated radiofrequency modified maze operation for the treatment of chronic atrial fibrillation (AF) and compare the results of the left and bi-atrial procedures. Material and method: During a period of two years, 105 patients with chronic AF having concomitant cardiac surgery underwent the procedure. Patients underwent either a bi-atrial (n = 48) or left atrial (n = 57) maze procedure. The first twenty patients underwent a bi-atrial maze procedure regardless of the pathology. In the following patients we adopted the bi-atrial approach in patients with a history of atrial flutter and where the right atrium has to be opened. Otherwise the procedure is restricted to the left atrial side. Mean age was 52 ± 11 years in bi-atrial group and 54 ± 9 years in left atrial group. Results: Three patients died early postoperatively (2.9%). There were 4 revisions for bleeding (3.8%). Two patients in bi-atrial group received a permanent pacemaker (4.1%). Patients in both groups were free of AF at the end of the procedure. (Bi-atrial group: sinus: 79.2%, pacemaker: 20.8%), (Left atrial group: sinus: 82.5%, pacemaker: 17.5%) (p > 0.05). During the last follow-up, sinus rhythm was maintained in 79.6% of cases in bi-atrial group, while this rate was 75.6% in left atrial group (p > 0.05). Conclusion: Saline irrigated radiofrequency modified maze procedure was performed safely and efficiently. Both the left and bi-atrial procedures were successful in terms of restoring sinus rhythm. Our current policy is to adopt the bi-atrial approach in patients with a history of atrial flutter and where the right atrium has to be opened. Otherwise the procedure is restricted to the left atrial side.

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