Higher F-wave frequency associates with poor procedural success rate after Maze procedure

Rena Usui, Masato Mutsuga, Yuji Narita, Yoshiyuki Tokuda, Sachie Terazawa, Hideki Ito, Wataru Uchida, Yasuya Inden, Toyoaki Murohara, Akihiko Usui

Research output: Contribution to journalArticlepeer-review


Objectives: Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure. Methods: In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002–2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program. Results: Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF (< 7.3 Hz) and higher voltage group (> 0.13 mV) showed a good rate (86%). Conclusions: The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.

Original languageEnglish
Pages (from-to)997-1004
Number of pages8
JournalGeneral Thoracic and Cardiovascular Surgery
Issue number12
Publication statusPublished - 12-2022
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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