Atrial flutter following a simplified maze procedure for cure of atrial fibrillation

Background: The Cox-maze operation for cure of atrial fibrillation is effective but technically difficult. It requires a long procedural time and has significant morbidity. Aim: To assess the efficacy and safety of a simplified maze operation. Methods: The new procedure was performed in 14 patients. The modified technique involved an incision encircling the pulmonary veins with an inferior vertical connecting incision to the posterior mitral annulus as in the Cox maze III procedure. A continuous incision passed from the left lateral mitral valve annulus to the left atrial appendage across the roof of the atria to the right atrial appendage and then inferoposteriorly across the right atrial free wall to the tricuspid valve annulus. The roof incision was extended into the interatrial septum. Both atrial appendages were excised. Results: No patient had a documented recurrence of atrial fibrillation. All patients experienced early (<3 months) atrial arrhythmias. Seven patients have no residual clinical arrhythmia (5 take medication). In 5 patients atrial flutter remained a long-term problem. There were 2 postoperative deaths. Conclusions: The simplified maze procedure incisions still result in cure of atrial fibrillation. However, this modification predisposes to atrial flutter. Further incisions aiming to prevent atrial flutter may improve the results.