Stiff left atrial syndrome after Mei mini maze procedure for atrial fibrillation: A retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Qi , DING Shiao , JIANG Xueyan , YUAN Yuan , LIU Hao ,  MEI Ju

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

MEI Ju, Email: meiju@xinhuamed.com.cn

Keywords：

Stiff left atrial syndrome; atrial fibrillation; Mei mini maze procedure

DOI：

10.7507/1007-4848.202206009

Video：

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Objective To analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.

Citation： YANG Qi, DING Shiao, JIANG Xueyan, YUAN Yuan, LIU Hao, MEI Ju. Stiff left atrial syndrome after Mei mini maze procedure for atrial fibrillation: A retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 434-438. doi: 10.7507/1007-4848.202206009 Copy

1.	García-Villarreal OA. Long-term effectiveness of the Cox-maze Ⅲ procedure and its relationship with left atrial postoperative size. Gaceta medica de Mexico, 2020, 155(6): 546-551.
2.	Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
3.	Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
4.	Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
5.	梅举, 姜兆磊, 刘兴鹏, 等. 微创外科-导管杂交消融术在长程持续性房颤治疗中的应用及疗效. 中华胸心血管外科杂志, 2018, 34(12): 724-728.
6.	Henein MY, Mondillo S, Cameli M. Left atrial function. Anatol J Cardiol, 2019, 22(2): 52-53.
7.	Ma N, Lu R, Zhao D, et al. Left atrial appendage fibrosis and 3-year clinical outcomes in atrial fibrillation after endoscopic ablation: A histologic analysis. Ann Thorac Surg, 2020, 109(1): 69-76.
8.	Pilote L, Hunter I, Marpole D, et al. Stiff left atrial syndrome. Can J Cardiol, 1988, 4: 255-257.
9.	Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm, 2017, 33(5): 369-409.
10.	Witt CM, Fenstad ER, Cha YM, et al. Increase in pulmonary arterial pressure after atrial fibrillation ablation: Incidence and associated findings. J Interv Card Electrophysiol, 2014, 40(1): 47-52.
11.	Gibson DN, Di Biase L, Mohanty P, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: Clinical characterization, prevalence, and predictors. Heart Rhythm, 2011, 8(9): 1364-1371.
12.	Kisheva A, Yotov Y. Risk factors for recurrence of atrial fibrillation. Anatol J Cardiol, 2021, 25(5): 338-345.
13.	Kranert M, Shchetynska-Marinova T, Liebe V, et al. Recurrence of atrial fibrillation in dependence of left atrial volume index. In Vivo, 2020, 34(2): 889-896.
14.	Hwang J, Park HS, Han S, et al. The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: Study using three-dimensional echocardiography. J Interv Card Electrophysiol, 2020, 57(1): 87-95.
15.	Bytyçi I, D'Agostino A, Bajraktari G, et al. Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes. Clin Physiol Funct Imaging, 2021, 41(2): 208-216.
16.	Homan EA, Reyes MV, Hickey KT, et al. Clinical overview of obesity and diabetes mellitus as risk factors for atrial fibrillation and sudden cardiac death. Front Physiol, 2019, 9: 1847.
17.	Ad N, Tian YY, Verbalis J, et al. The effect of the maze procedure on the secretion of arginine-vasopressin and aldosterone. J Thorac Cardiovasc Surg, 2003, 126(4): 1095-1100.
18.	Wong GR, Lau DH, Baillie TJ, et al. Novel use of sildenafil in the management of pulmonary hypertension due to post-catheter ablation 'stiff left atrial syndrome'. Int J Cardiol, 2015, 181: 55-56.
19.	Maeder MT, Nägele R, Rohner P, et al. Pulmonary hypertension in stiff left atrial syndrome: Pathogenesis and treatment in one. ESC Heart Fail, 2018, 5(1): 189-192.
20.	Zaidi D, Williams D, Zhao D, et al. Interatrial stent to treat stiff left atrium syndrome. Cardiovasc Revasc Med, 2022, 40S: 337-340.

1. García-Villarreal OA. Long-term effectiveness of the Cox-maze Ⅲ procedure and its relationship with left atrial postoperative size. Gaceta medica de Mexico, 2020, 155(6): 546-551.
2. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
3. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
4. Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
5. 梅举, 姜兆磊, 刘兴鹏, 等. 微创外科-导管杂交消融术在长程持续性房颤治疗中的应用及疗效. 中华胸心血管外科杂志, 2018, 34(12): 724-728.
6. Henein MY, Mondillo S, Cameli M. Left atrial function. Anatol J Cardiol, 2019, 22(2): 52-53.
7. Ma N, Lu R, Zhao D, et al. Left atrial appendage fibrosis and 3-year clinical outcomes in atrial fibrillation after endoscopic ablation: A histologic analysis. Ann Thorac Surg, 2020, 109(1): 69-76.
8. Pilote L, Hunter I, Marpole D, et al. Stiff left atrial syndrome. Can J Cardiol, 1988, 4: 255-257.
9. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm, 2017, 33(5): 369-409.
10. Witt CM, Fenstad ER, Cha YM, et al. Increase in pulmonary arterial pressure after atrial fibrillation ablation: Incidence and associated findings. J Interv Card Electrophysiol, 2014, 40(1): 47-52.
11. Gibson DN, Di Biase L, Mohanty P, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: Clinical characterization, prevalence, and predictors. Heart Rhythm, 2011, 8(9): 1364-1371.
12. Kisheva A, Yotov Y. Risk factors for recurrence of atrial fibrillation. Anatol J Cardiol, 2021, 25(5): 338-345.
13. Kranert M, Shchetynska-Marinova T, Liebe V, et al. Recurrence of atrial fibrillation in dependence of left atrial volume index. In Vivo, 2020, 34(2): 889-896.
14. Hwang J, Park HS, Han S, et al. The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: Study using three-dimensional echocardiography. J Interv Card Electrophysiol, 2020, 57(1): 87-95.
15. Bytyçi I, D'Agostino A, Bajraktari G, et al. Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes. Clin Physiol Funct Imaging, 2021, 41(2): 208-216.
16. Homan EA, Reyes MV, Hickey KT, et al. Clinical overview of obesity and diabetes mellitus as risk factors for atrial fibrillation and sudden cardiac death. Front Physiol, 2019, 9: 1847.
17. Ad N, Tian YY, Verbalis J, et al. The effect of the maze procedure on the secretion of arginine-vasopressin and aldosterone. J Thorac Cardiovasc Surg, 2003, 126(4): 1095-1100.
18. Wong GR, Lau DH, Baillie TJ, et al. Novel use of sildenafil in the management of pulmonary hypertension due to post-catheter ablation 'stiff left atrial syndrome'. Int J Cardiol, 2015, 181: 55-56.
19. Maeder MT, Nägele R, Rohner P, et al. Pulmonary hypertension in stiff left atrial syndrome: Pathogenesis and treatment in one. ESC Heart Fail, 2018, 5(1): 189-192.
20. Zaidi D, Williams D, Zhao D, et al. Interatrial stent to treat stiff left atrium syndrome. Cardiovasc Revasc Med, 2022, 40S: 337-340.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Stiff left atrial syndrome after Mei mini maze procedure for atrial fibrillation: A retrospective study

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