Randomized study of surgical correction of permanent atrial fibrillation: preliminary results

Objective: To comparatively analyze the results of techniques in the treatment of atrial fibrillation: the Maze procedure and Isolation of Pulmonary Veins were compared together with a control group, to establish the best treatment for this arrhythmia. Method: All patients were referred for surgery for other cardiac lesions, which were treated concomitantly. From July 1999 to September 2003 fifty-one patients were randomly allocated to the different groups. No cryoablation or other source of energy was used. The following variables were initially analyzed: total bypass time, aortic clamping time, sinus rhythm at discharge and trans-operative and immediate postoperative complications. Results: There were two intra-hospital deaths, one in the Maze group and one in the Isolation of Pulmonary Veins group. The Maze group had the longest bypass time (p<0.001). The duration of follow-up of 28.4 ± 14 months was similar between the groups. The Isolation of Pulmonary Veins achieved the best results concerning reversion to sinus rhythm with 84.2% at hospital discharge and 88.9% after follow-up. In the Maze group, 78.5% of sinus rhythm was seen at discharge and 84.6% at the end of follow-up. In the Control group 87.5% of the patients had atrial fibrillation at discharge and after follow-up, atrial fibrillation remained at 56.3% of the patients. There was no difference in the NYHA class between the groups after follow-up (p=0.56) and Control group patients had more complications (p=0.017). Conclusion: These results show that both techniques, the Maze and Isolation of Pulmonary Veins, have advantages over simple correction of cardiac lesions when associated to atrial fibrillation.