| Abstract [eng] |
Aim of the research: To examine long-term efficacy in atrial fibrillation patients following the Cox-Maze procedure in Vilnius university hospital Santaros clinics. Methodology, study participants: A retrospective analysis was performed of anonymized patient data from Vilnius University hospital Santaros clinics, Cardiac and Thoracic Surgery Center, that underwent minimally invasive surgical ablation for atrial fibrillation from 2008 to 2015. Only patients who have signed a written consent were included in the analysis. Electrocardiogram and Holter monitoring were conducted at 1, 3, 6 months and yearly afterwards until 2023 to confirm sinus rhythm. Analysed dataset consisted of demographic information, medical history (disease and life anamnesis), surgical protocols and outpatient visit transcripts. Results: The data of 127 patients were examined, of which 100 were men with mean age of 50.75±9.36. Average time of atrial fibrillation until surgery was 69.49 months, with persistent type being the leading one (80.3%). 1 year postoperatively freedom from atrial fibrillation was observed in 54.4% of all patients; after 5 years – 34.3%; after 10 years – 14.7%; after 15 years – only 9.8%. A statistically significant meaning was established between atrial fibrillation recurrence risk and pulmonary vein isolation (2.741; 95 % PI 1.719–4.369; p < 0.001) as well as Marshall ligament dissection (2.197; 95 % PI 1.421–3.396; p < 0,001). Arrhythmia recurrence risk was also associated with early postoperative tachyarrhythmias (2.460; 95 % PI 1.581-3.826; p < 0.001). There was a visible difference among different ablation systems used in the procedure (p<0.004). 22 (17.32%) patients had postoperative complications that had long-term impact. Repeated catheter ablation was performed for 39 patients with a strong statistical relationship with persistent atrial fibrillation and absence of pulmonary vein isolation (p<0.001). However, from these 39 patients, only 6 patients had sinus rhythm during last visit. 19 patients had pacemakers implanted after the Cox-maze procedure. Conclusions: It was determined that the rate of atrial fibrillation recurrence increased over time and was similar when compared with other medical institutions worldwide. A statistically meaningful relationship was established between surgical efficacy and employed ablation system, intraoperative factors (pulmonary vein isolation, dissection of the ligament of Marshall) and early postoperative tachyarrhythmia. It was determined that additional catheter ablation and/or pacemaker implantation were the most frequent needed postoperative interventions. A correlation was seen between need for an additional catheter ablation and failure to perform pulmonary vein isolation. Additionally, persisting arrythmia recurrence was observed after additional catheter ablation procedures. |
