Journal of thoracic disease · 2026
Pacemaker implantation after concomitant maze procedure and mitral valve repair in atrial functional mitral regurgitation.
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Woo Jung Uk, Yoon Sungsil, Jang Woo Sung, Kim Yun Seok, Bae YoHan, Lee Hee Jeong, Yoo Jonghoon, Song Kyungsub
Аннотация
BACKGROUND: Atrial functional mitral regurgitation (AFMR) is caused by atrial enlargement and mitral annular dilation due to atrial fibrillation (AF). Although the outcomes of mitral valve surgery in AFMR have been reported, concomitant Maze procedure outcomes in AFMR remain poorly understood. This study aimed to evaluate the clinical and rhythm outcomes of concomitant mitral valve plasty and the Maze procedure in patients with AFMR.
METHODS: We retrospectively analyzed 122 patients who underwent the mitral valve plasty (repair) concomitant with Maze procedure between August 2010 and June 2025. The cohort was divided into an AFMR group (n=50) and a non-AFMR group (n=72). The cumulative incidence of permanent pacemaker (PPM) implantation was analyzed using the Fine-Gray subdistribution hazard model with death as a competing risk. Postoperative rhythm dynamics were evaluated using a continuous-time multi-state Markov model.
RESULTS: The overall cumulative incidence of PPM implantation was significantly higher in the AFMR group than in the non-AFMR group (P<0.001). While early (≤30 days) PPM implantation rates did not differ (P=0.53), the AFMR group showed a higher risk of late (>30 days) PPM implantation (P<0.001). Multivariable analysis identified AFMR as an independent risk factor of late PPM implantation [subdistribution hazard ratios (sHR) 14.963, P=0.02]. Furthermore, the AFMR group demonstrated a higher rate of postoperative junctional rhythm compared to the non-AFMR group.
CONCLUSIONS: AFMR was not associated with a statistically significant difference in overall survival and the incidence of major adverse cardiovascular events following the Maze procedure compared to the non-AFMR group. However, AFMR was associated with a higher risk of transition to junctional rhythm following the Maze procedure, which was associated with an increased rate of PPM implantation. Notably, the risk of pacemaker implantation was predominantly late-onset, which may be due to a progressive decline in sinus node function. Therefore, close long-term rhythm monitoring and follow-up are warranted.
METHODS: We retrospectively analyzed 122 patients who underwent the mitral valve plasty (repair) concomitant with Maze procedure between August 2010 and June 2025. The cohort was divided into an AFMR group (n=50) and a non-AFMR group (n=72). The cumulative incidence of permanent pacemaker (PPM) implantation was analyzed using the Fine-Gray subdistribution hazard model with death as a competing risk. Postoperative rhythm dynamics were evaluated using a continuous-time multi-state Markov model.
RESULTS: The overall cumulative incidence of PPM implantation was significantly higher in the AFMR group than in the non-AFMR group (P<0.001). While early (≤30 days) PPM implantation rates did not differ (P=0.53), the AFMR group showed a higher risk of late (>30 days) PPM implantation (P<0.001). Multivariable analysis identified AFMR as an independent risk factor of late PPM implantation [subdistribution hazard ratios (sHR) 14.963, P=0.02]. Furthermore, the AFMR group demonstrated a higher rate of postoperative junctional rhythm compared to the non-AFMR group.
CONCLUSIONS: AFMR was not associated with a statistically significant difference in overall survival and the incidence of major adverse cardiovascular events following the Maze procedure compared to the non-AFMR group. However, AFMR was associated with a higher risk of transition to junctional rhythm following the Maze procedure, which was associated with an increased rate of PPM implantation. Notably, the risk of pacemaker implantation was predominantly late-onset, which may be due to a progressive decline in sinus node function. Therefore, close long-term rhythm monitoring and follow-up are warranted.