Relevance of the Atrial Substrate Remodeling during Follow-Up to Predict Preoperatively Atrial Fibrillation Cox-Maze Surgery Outcome

Although atrial fibrillation (AF) is the most common cardiac arrhythmia, the knowledge about its causes and mechanisms still is uncompleted. Several studies suggest that structural and electrophysiological remodeling are directly related to its development and perpetuation. To this respect, the surface electrocardiogram (ECG) has been used to assess different aspects of atrial remodeling. However, specific ECG parameters have never been used to provide valuable clinical information in the study of AF aggressive treatments, such as the Cox-Maze surgery. In this work, parameters from the fibrillatory (

f

) waves, such as their regularity or their amplitude, are studied after a six months follow-up period from the Cox-Maze surgery. This study culminates previous works on Cox-Maze outcome prognosis at discharge and after the blanking period. The results obtained reported a remarkable prediction capability decrease of the preoperative ECG parameters, with respect to similar studies at the time of discharge and after the surgery blanking period. More concretely, the prognosis accuracy of the

f

waves amplitude, the dominant atrial frequency and the

f

waves regularity was 58.3%, 62.5% and 66.6%, respectively. Pharmacological and electrical cardioversion treatments administered during the follow-up period could be the main reason to this result. Therefore, atrial substrate remodeling during the follow-up causes a remarkable influence on the preoperative surgery outcome prognosis based on the

f

waves analysis.