Left Ventricular Dysfunction in Atrial Fibrillation: Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status

John M. Stulak, Joseph A. Dearani, Richard C. Daly, Kenton J Zehr, Thoralf M. Sundt, Hartzell V. Schaff

Research output: Contribution to journalArticle

Abstract

Background: Atrial flutter or fibrillation with rapid, uncontrolled ventricular response may lead to left ventricular dysfunction, and conversion to sinus rhythm with control of heart rate can improve left ventricular ejection fraction. Little is known about the effects of the Cox-maze procedure on this form of tachycardia-induced cardiomyopathy. Methods: Four hundred forty-three patients underwent the Cox-maze procedure from 1993 to 2002. Ninety-nine had atrial flutter or fibrillation without associated valvular or congenital heart disease, and 37 (37%) had decreased left ventricular function (ejection fraction <0.35 in 11 [severe], ejection fraction 0.36 to 0.45 in 8 [moderate], and ejection fraction 0.46 to 0.55 in 18 [mild]). Ages of these 37 patients (34 male) ranged from 35 to 74 years (median, 55 years). Results: Atrial flutter or fibrillation was present for 3 months to 19 years (median, 48 months) preoperatively, and 24 patients (65%) exhibited symptoms of heart failure. Preoperative ejection fraction ranged from 0.25 to 0.55 (median, 0.45). At last follow-up (median, 63 months), the Cox-maze procedure eliminated atrial flutter or fibrillation in all but 1 patient, and the greatest improvement was observed in patients with severe preoperative impairment (0.31 to 0.53; p = 0.01, preoperative versus follow-up), and patients with preoperative chronic atrial flutter or fibrillation (0.43 to 0.55; p <0.05 preoperative versus follow-up). This improvement was observed immediately postoperatively and was sustained at last follow-up. Further, improvement in left ventricular function correlated with enhancement of functional status. Conclusions: In some patients, atrial flutter or fibrillation may be the cause rather than the consequence of left ventricular dysfunction. Importantly, systolic function and functional status can be significantly improved with the restoration of sinus rhythm by the Cox-maze procedure.

Original languageEnglish (US)
Pages (from-to)494-501
Number of pages8
JournalAnnals of Thoracic Surgery
Volume82
Issue number2
DOIs
StatePublished - Aug 2006
Externally publishedYes

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Left Ventricular Dysfunction
Atrial Flutter
Atrial Fibrillation
Left Ventricular Function
Stroke Volume
Cardiomyopathies
Tachycardia
Heart Failure
Heart Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Left Ventricular Dysfunction in Atrial Fibrillation : Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status. / Stulak, John M.; Dearani, Joseph A.; Daly, Richard C.; Zehr, Kenton J; Sundt, Thoralf M.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 82, No. 2, 08.2006, p. 494-501.

Research output: Contribution to journalArticle

Stulak, John M. ; Dearani, Joseph A. ; Daly, Richard C. ; Zehr, Kenton J ; Sundt, Thoralf M. ; Schaff, Hartzell V. / Left Ventricular Dysfunction in Atrial Fibrillation : Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 2. pp. 494-501.
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title = "Left Ventricular Dysfunction in Atrial Fibrillation: Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status",
abstract = "Background: Atrial flutter or fibrillation with rapid, uncontrolled ventricular response may lead to left ventricular dysfunction, and conversion to sinus rhythm with control of heart rate can improve left ventricular ejection fraction. Little is known about the effects of the Cox-maze procedure on this form of tachycardia-induced cardiomyopathy. Methods: Four hundred forty-three patients underwent the Cox-maze procedure from 1993 to 2002. Ninety-nine had atrial flutter or fibrillation without associated valvular or congenital heart disease, and 37 (37{\%}) had decreased left ventricular function (ejection fraction <0.35 in 11 [severe], ejection fraction 0.36 to 0.45 in 8 [moderate], and ejection fraction 0.46 to 0.55 in 18 [mild]). Ages of these 37 patients (34 male) ranged from 35 to 74 years (median, 55 years). Results: Atrial flutter or fibrillation was present for 3 months to 19 years (median, 48 months) preoperatively, and 24 patients (65{\%}) exhibited symptoms of heart failure. Preoperative ejection fraction ranged from 0.25 to 0.55 (median, 0.45). At last follow-up (median, 63 months), the Cox-maze procedure eliminated atrial flutter or fibrillation in all but 1 patient, and the greatest improvement was observed in patients with severe preoperative impairment (0.31 to 0.53; p = 0.01, preoperative versus follow-up), and patients with preoperative chronic atrial flutter or fibrillation (0.43 to 0.55; p <0.05 preoperative versus follow-up). This improvement was observed immediately postoperatively and was sustained at last follow-up. Further, improvement in left ventricular function correlated with enhancement of functional status. Conclusions: In some patients, atrial flutter or fibrillation may be the cause rather than the consequence of left ventricular dysfunction. Importantly, systolic function and functional status can be significantly improved with the restoration of sinus rhythm by the Cox-maze procedure.",
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T1 - Left Ventricular Dysfunction in Atrial Fibrillation

T2 - Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status

AU - Stulak, John M.

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Zehr, Kenton J

AU - Sundt, Thoralf M.

AU - Schaff, Hartzell V.

PY - 2006/8

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AB - Background: Atrial flutter or fibrillation with rapid, uncontrolled ventricular response may lead to left ventricular dysfunction, and conversion to sinus rhythm with control of heart rate can improve left ventricular ejection fraction. Little is known about the effects of the Cox-maze procedure on this form of tachycardia-induced cardiomyopathy. Methods: Four hundred forty-three patients underwent the Cox-maze procedure from 1993 to 2002. Ninety-nine had atrial flutter or fibrillation without associated valvular or congenital heart disease, and 37 (37%) had decreased left ventricular function (ejection fraction <0.35 in 11 [severe], ejection fraction 0.36 to 0.45 in 8 [moderate], and ejection fraction 0.46 to 0.55 in 18 [mild]). Ages of these 37 patients (34 male) ranged from 35 to 74 years (median, 55 years). Results: Atrial flutter or fibrillation was present for 3 months to 19 years (median, 48 months) preoperatively, and 24 patients (65%) exhibited symptoms of heart failure. Preoperative ejection fraction ranged from 0.25 to 0.55 (median, 0.45). At last follow-up (median, 63 months), the Cox-maze procedure eliminated atrial flutter or fibrillation in all but 1 patient, and the greatest improvement was observed in patients with severe preoperative impairment (0.31 to 0.53; p = 0.01, preoperative versus follow-up), and patients with preoperative chronic atrial flutter or fibrillation (0.43 to 0.55; p <0.05 preoperative versus follow-up). This improvement was observed immediately postoperatively and was sustained at last follow-up. Further, improvement in left ventricular function correlated with enhancement of functional status. Conclusions: In some patients, atrial flutter or fibrillation may be the cause rather than the consequence of left ventricular dysfunction. Importantly, systolic function and functional status can be significantly improved with the restoration of sinus rhythm by the Cox-maze procedure.

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