Trial reportThe Journal of thoracic and cardiovascular surgery2019
Biatrial maze procedure versus pulmonary vein isolation for atrial fibrillation during mitral valve surgery: New analytical approaches and end points.
Trial report in The Journal of thoracic and cardiovascular surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis.Journal of cardiothoracic surgery · 2023Pooled it
- Comparing mid-term outcomes of Cox-Maze procedure and pulmonary vein isolation for atrial fibrillation after concomitant mitral valve surgery: A systematic review.Journal of cardiac surgery · 2022Pooled it
- Epicardial muscle bundles in persistent atrial fibrillation: from overlooked bystanders to arrhythmogenic modulators.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Review
- Postoperative 4-chamber cardiac function and outcomes following biatrial or left atrial Maze procedure for concomitant atrial fibrillation.JTCVS open · 2026Article
- How we do it: Biatrial maze.JTCVS structural and endovascular · 2024Article
- Surgical ablation of atrial fibrillation is associated with improved survival compared with appendage obliteration alone: An analysis of 100,000 Medicare beneficiaries.The Journal of thoracic and cardiovascular surgery · 2024Article
- Surgical treatment of atrial fibrillation in mitral valve surgery: a narrative review.Journal of thoracic disease · 2024Review
- 2023 APHRS expert consensus statements on surgery for AF.Journal of arrhythmia · 2023Article
- Three Ablation Techniques for Atrial Fibrillation during Concomitant Cardiac Surgery: A Systematic Review and Network Meta-Analysis.Journal of clinical medicine · 2023Review
- Commentary: What is the measure of success for atrial fibrillation ablation? Is a reduction in arrhythmia burden sufficient?The Journal of thoracic and cardiovascular surgery · 2023Article
- The maze IV operation is not always the best choice: Matching the procedure to the patient.JTCVS techniques · 2023Article
- Mid-term outcomes of concomitant Cox-Maze IV: Results from a multicenter prospective registry.Journal of cardiac surgery · 2022Article
- Effect of Preablation Glycemic Control on Outcomes of Atrial Fibrillation Patients With Diabetes Mellitus Following Valvular Surgery Combined With the Cox-Maze IV Procedure.Frontiers in cardiovascular medicine · 2022Article
- Dynamic electrophysiological mechanism in patients with long-standing persistent atrial fibrillation.Frontiers in cardiovascular medicine · 2022Article
- Long-Term Outcomes of Surgical Ablation for Atrial Fibrillation: Impact of Ablation Lesion Sets.JACC. Asia · 2021Article
- Mitral isthmus block is associated with favorable outcomes after reablation for long-standing persistent atrial fibrillation.Clinical cardiology · 2020Article
- Contemporary Surgical Management of Atrial Fibrillation.The International journal of angiology : official publication of the International College of Angiology, Inc · 2020Article
- The inadvertent compounding of misconceptions regarding the surgical treatment of atrial fibrillation in mitral valve patients.Journal of thoracic disease · 2019Article
- Outcome of concomitant left atrial ablation during valvular heart surgery: an African perspective.Cardiovascular journal of AfricaArticle
Corrections and comments
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Authors and funding
21 authors at 15 institutions in 2 countries.
Funding
Abstract
objectiveTo use novel statistical methods for analyzing the effect of lesion set on (long-standing) persistent atrial fibrillation (AF) in the Cardiothoracic Surgical Trials Network trial of surgical ablation during mitral valve surgery (MVS).
methodsTwo hundred sixty such patients were randomized to MVS + surgical ablation or MVS alone. Ablation was randomized between pulmonary vein isolation and biatrial maze. During 12 months postsurgery, 228 patients (88%) submitted 7949 transtelephonic monitoring (TTM) recordings, analyzed for AF, atrial flutter (AFL), or atrial tachycardia (AT). As previously reported, more ablation than MVS-alone patients were free of AF or AF/AFL at 6 and 12 months (63% vs 29%; P < .001) by 72-hour Holter monitoring, without evident difference between lesion sets (for which the trial was underpowered).
resultsEstimated freedom from AF/AFL/AT on any transmission trended higher after biatrial maze than pulmonary vein isolation (odds ratio, 2.31; 95% confidence interval, 0.95-5.65; P = .07) 3 to 12 months postsurgery; estimated AF/AFL/AT load (ie, proportion of TTM strips recording AF/AFL/AT) was similar (odds ratio, 0.90; 95% confidence interval, 0.57-1.43; P = .6). Within 12 months, estimated prevalence of AF/AFL/AT by TTM was 58% after MVS alone, and 36% versus 23% after pulmonary vein isolation versus biatrial maze (P < .02).
conclusionsStatistical modeling using TTM recordings after MVS in patients with (long-standing) persistent AF suggests that a biatrial maze is associated with lower AF/AFL/AT prevalence, but not a lower load, compared with pulmonary vein isolation. The discrepancy between AF/AFL/AT prevalence assessed at 2 time points by Holter monitoring versus weekly TTM suggests the need for a confirmatory trial, reassessment of definitions for failure after ablation, and validation of statistical methods for assessing atrial rhythms longitudinally.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.