Incidence of sinus node dysfunction in patients with long-standing, persistent atrial fibrillation who require simultaneous surgical correction of mitral and tricuspid valve defects and the “Maze IIIB” procedure

Background. Atrial fibrillation (AF) is the most common disorder of heart rhythm. A series of “Maze” surgery was developed, among which the “Maze III” modification is presently a gold standard for surgical treatment of AF. Aim. To study the sinoatrial node (SAN) function before and after the “Maze III” surgery. Materials and methods. The study included 100 patients (48 males) with persistent and long-standing persistent AF and valve abnormality. Mean age of patients was 59 years and mean AF duration - 4 years. Tachysystolic AF prevailed (62%); normosystolic AF was observed in 31% of patients; and bradysystolic - in 7% of patients. Electric cardioversion was performed for all patients according to the standard method. After successful recovery of the sinus rhythm, the endocardial elec-trophysiological study (EPS) of the heart was performed. Correction of valve pathology and the “Maze IIIB” surgery were performed on days 1-2 following EPS. The SAN function was evaluated by the time of function recovery (SAN TFR). Results. Using electric cardioversion, the sinus rhythm was restored in all patients. EPS showed abnormal prolongation of the corrected time for the SAN function recovery (CTSANFR) and sinoatrial conduction time (SACT) in 11% of patients. In 2% of patients, the abnormal prolongation of SACT was an isolated conduction disorder. In total, 13% of patients had SAN dysfunction (SAND). These patients received implantable electric cardioverters after a surgical intervention (correction of valve abnormality and “Maze III”). The sinus rhythm recovered immediately after the surgery. 0n day 7, steady sinus rhythm was observed in 46% of patients. During the postperfusion period and on the first day postsurgery, 62% of patients had replacement atrioventricular nodal rhythm. By the time of discharge from the hospital, the nodal rhythm was observed in 25% of patients. Starting from day 2, the replacement atrial rhythm developed in 13% of patients, and by the time of discharge from the hospital, 24% of patients had a stable atrial rhythm. Conclusion. Effectiveness of the surgical treatment for persistent and long-standing persistent AF (modified “Maze IIIB” surgery with simultaneous correction of the mitral valve (MV) and the tricuspid valve (TV)) in the early postsurgery period was 95%. According to data of preoperative endocardial EPS, SAND was observed in 13% of patients. Following the surgical correction of MV and TV defects and the criomodification of the “Maze IIIB” surgery, signs of SAND requiring implantation of an electric cardioverter were observed in a total of 24% of patients.

дисфункция синусового узла, персистирующая форма фибрилляции предсердий, митральный клапан, трикуспидальный клапан, операция «Лабиринт IIIB», sinus node dysfunction, persistent atrial fibrillation, mitral valve, tricuspid valve, Maze IIIB procedure

1. Бокерия Л.А., Ревишвили А.Ш., Шмуль А.В., Джорджикия Т.Р., Кваша Б.И., Мацонашвили Г. Р. и др. Результаты хирургического лечения фибрилляции предсердий у пациентов с пороками сердца. Анналы аритмологии. 2012; 9 (4): 14-22 [Bokeriya L. A., Revishvili A. Sh., Shmul' A. V., Dzhordzhikiya T. R., Kvasha B. I., Maczonashvili G. R. i dr. Rezul'taty' xirurgicheskogo lecheniya fibrillyaczii predserdij u paczientov s porokami serdcza. Annaly' aritmologii. 2012; 9 (4): 14-22].

2. Бокерия Л.А., Ревишвили А.Ш., Ольшанский М.С. Хирургическое лечение фибрилляции предсердий: опыт и перспективы развития. Грудная и сердечно-сосудистая хирургия. 1998; (1): 7-14 [Bokeriya L. A., Revishvili A. Sh., Ol'shanskij M. S. Xirurgiches-koe lechenie fibrillyaczii predserdij: opy't i perspektivy' razvitiya. Grudnaya i serdechno-sosudistaya xirurgiya. 1998; (1): 7-14].

3. Бокерия Л.А., Ревишвили А.Ш. Современные подходы к нефармакологическому лечению фибрилляции предсердий. Анналы аритмологии. 2005; 2 (2): 49-67 [Bokeriya L. A., Revishvili A. Sh. Sovremenny'e podxody' k nefarmakologicheskomu lecheniyu fibrillyaczii predserdij. Annaly' aritmologii. 2005; 2 (2): 49-67].

4. Williams J.M., Ungerleider R.M., Lofland G.K., Cox J.L. Left atrial isolation: new technique for the treatment of supraventricular arrhythmias. J. Thorac Cardiovasc Surg. 1980; 80 (3): 373-80.

5. Guiraudon G.M., Klein G.J., Yee R., Leitch J.W., Kaushik R.R., McLellan D.G. Surgery for atrial tachycardia. Pacing Clin Electrophysiol. 1990; 13 (12 Pt 2): 1996-9.

6. Бокерия Л.А., Ревишвили А.Ш., Муратов Р.М., Рычин С.В., Умаров В.М., Сергуладзе С.Ю. Результаты хирургического лечения хронической фибрилляции предсердий у больных с пороками митрального клапана. Анналы аритмологии. 2004; 1 (1): 64-70 [Bokeriya L. A., Revishvili A. Sh., Muratov R. M., Ry'chin S. V., Umarov V. M., Serguladze S. Yu. Rezul'taty' xirurgicheskogo lecheniya xronicheskoj fibrillyaczii predserdij u bol'ny'x s porokami mitral'nogo klapana. Annaly' aritmologii. 2004; 1 (1): 64-70].

7. Cox J.L., Boineau J.P., Schuessler R.B., Kater K.M., Lappas D.G. Fiveyear experience with the maze procedure for atrial fibrillation. Ann Thorac Surg. 1993; 56 (4): 814-823; discussion 823-824.

8. Kosakai Y., Kawaguchi A.T., Isobe F., Sasako Y., Nakano K., Eishi K. et al. Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease. J. Thorac Cardiovasc Surg. 1994; 108 (6): 1049-1054; discussion 1054-1055.

9. Izumoto H., Kawazoe K., Kitahara H., Nasu M., Sasaki T., Kamata J. et al. Can the maze procedure be combined safely with mitral valve repair? J. Heart Valve Dis. 1997; 6 (2): 166-70.

10. Josephson M.E. Josephson's Clinical Cardiac Electrophysiology [Internet]. 5 th edition. Lippincott Williams & Wilkins; 2015 [cited 2017]. 890 p. Available from: https://nls.ldls.org.uk/welcome.html?ark:/81055/vdc_100031454446.0x000001

11. Бокерия Л.А., Бокерия О.Л., Шварц В.А., Санакоев М.К., Испирян А.Ю., Фатулаев З.Ф. и др. Непосредственные результаты одномоментной хирургической коррекции фибрилляции предсердий и сложной патологии сердца. Новости хирургии. 2016; 24 (3): 227-33 [Bokeriya L. A., Bokeriya O. L., Shvarcz V. A., Sanakoev M. K., Ispiryan A. Yu., Fatulaev Z. F. i dr. Neposredstvenny' e rezul' taty' odnomomentnoj xirurgicheskoj korrekczii fibrillyaczii predserdij i slozhnoj patologii serdcza. Novosti xirurgii. 2016; 24 (3): 227-33].

12. Kobayashi J., Yamamoto F., Nakano K., Sasako Y., Kitamura S., Kosakai Y. Maze procedure for atrial fibrillation associated with atrial septal defect. Circulation. 1998; 98 (19 Suppl): II399-402.

13. Kalman J.M., Olgin J.E., Karch M.R., Hamdan M., Lee R.J., Lesh M.D. 'Cristal tachycardias': origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J. Am Coll Cardiol. 1998; 31 (2): 451-9.

14. Man K.C., Knight B., Tse H.F., Pelosi F., Michaud G.F., Flemming M. et al. Radiofrequency catheter ablation of inappropriate sinus tachycardia guided by activation mapping.J. Am Coll Cardiol. 2000; 35 (2): 451-7.

15. Haqqani H.M., Kalman J.M. Aging and sinoatrial node dysfunction: musings on the not-so-funny side. Circulation. 2007; 115 (10): 1178-9. DOI: 10.1161/CIRCULATIONAHA.106.685248.

16. Lee R.J., Kalman J.M., Fitzpatrick A.P., Epstein L.M., Fisher W.G., Olgin J.E. et al. Radiofrequency catheter modification of the sinus node for 'inappropriate' sinus tachycardia. Circulation. 1995; 92 (10): 2919-28.

17. Kalman J.M., Lee R.J., Fisher W.G., Chin M.C., Ursell P., Stillson C.A. et al. Radiofrequency catheter modification of sinus pacemaker function guided by intracardiac echocardiography. Circulation. 1995; 92 (10): 3070-81.

18. Pokushalov E., Romanov A., Elesin D., Bogachev-Prokophiev A., Losik D., Bairamova S. et al. Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: a randomized controlled trial. J. Cardiovasc Electrophysiol. 2013; 24 (12): 1338-43. DOI: 10.1111/jce.12245.

19. Ghavidel A.A., Javadpour H., Shafiee M., Tabatabaie M.-B., Raiesi K., Hosseini S. Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation. EurJ Cardiothorac Surg. 2008; 33 (6): 1043-8. DOI: 10.1016/j.ejcts.2008.03.019.

20. Ad N., Henry L.L., Holmes S.D., Hunt S.L. The impact of surgical ablation for atrial fibrillation in high-risk patients. Ann Thorac Surg. 2012; 93 (6): 1897-1903; discussion 1903-1904. DOI: 10.1016/j.athoracsur.2012.02.094.

21. Singh S., Johnson P.I., Lee R.E., Orfei E., Lonchyna V.A., Sullivan H.J. et al. Topography of cardiac ganglia in the adult human heart. J. Thorac Cardiovasc Surg. 1996; 112 (4): 943-53. DOI: 10.1016/S0022-5223 (96) 70094-6.

22. Sánchez-Quintana D., Cabrera J.A., Farré J., Climent V., Anderson R.H., Ho S.Y. Sinus node revisited in the era of electroanatomical mapping and catheter ablation. Heart. 2005; 91 (2): 189-94. DOI: 10.1136/hrt.2003.031542.

23. Ordway G.A., Charles J.B., Randall D.C., Billman G.E., Wekstein D.R. Heart rate adaptation to exercise training in cardiac-denervated dogs. J. Appl Physiol Respir Environ Exerc Physiol. 1982; 52 (6): 1586-90.

24. Albage A., Lindblom D., Insulander P., Kennebäck G. Electrophysiol ogical evaluation of the sinus node and the cardiac conduction system following the maze procedure for atrial fibrillation. Pacing Clin Electrophysiol. 2004; 27 (2): 194-203.

25. Cox J.L., Jaquiss R.D., Schuessler R.B., Boineau J.P. Modification of the maze procedure for atrial flutter and atrial fibrillation. I.I. Surgical technique of the maze III procedure. J. Thorac Cardiovasc Surg. 1995; 110 (2): 485-95. DOI: 10.1016/S0022-5223 (95) 70245-8.