Maze surgery normalizes left ventricular function in patients with persistent lone atrial fibrillation

Alberto Pozzoli, Maurizio Taramasso, Giuditta Coppola, Mikel Kamami, Giovanni La Canna, Paolo Della Bella, Ottavio Alfieri, Stefano Benussi

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: The aim of this study is to evaluate the mid-term clinical and functional outcomes of maze surgery in symptomatic refractory lone atrial fibrillation (AF) patients.

METHODS: Between March 2008 and January 2013, 39 highly symptomatic patients [mean age 51 ± 10 (mean ± standard deviation); 95% CI, European Heart Rhythm Association class III-IV] underwent maze surgery for lone AF. Biatrial ablations were performed with bipolar radiofrequency and cryoenergy, according to a maze III lesion set (modified by omitting the intercaval line in 5 of 39 patients). Mean ejection fraction was 51 ± 9% (range 17-60),

RESULTS: A minimally invasive approach was adopted in 22 patients (56%). Major complications were 1 mediastinitis, 1 re-exploration for bleeding and 2 pacemaker (5%) implantation. At a mean follow-up of 29.4 ± 14.2 months, freedom from arrhythmias was 92 and 93% at 24 and 36 months, respectively. Freedom without antiarrhythmic drugs was 75 and 85% at 24 and 36 months, respectively. Ejection fraction normalized in all cases, from 51.3 ± 9% to 61.1 ± 3% (P <0.001) overall, and from 37.0 ± 10% to 60.3 ± 3% (P <0.001) when ≤ 45% preoperatively. AF-related symptoms score decreased to class I in 36 patients (93%). No early or late stroke occurred.

CONCLUSIONS: Within a dedicated AF centre, maze surgery grants excellent outcomes, with symptoms relief and negligible risk. It provides a complete reversal of arrhythmia-related myocardial dysfunction and is therefore a convenient alternative to His bundle ablation and lifelong pacemaker dependency in symptomatic refractory patients.

Original languageEnglish
Pages (from-to)871-876
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number5
Publication statusPublished - Nov 1 2014


  • Arrhythmias
  • Atrial fibrillation ablation
  • Congestive heart failure
  • Electrophysiology
  • Maze surgery
  • Minimally invasive surgery
  • Transcatheter ablation

ASJC Scopus subject areas

  • Medicine(all)


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