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July 24, 2026Journal of Cardiothoracic SurgeryOpen Access

Post-Maze junctional rhythm fails to achieve reverse remodeling, showing worse left atrial strain versus NSR.

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Why the study?

Does junctional rhythm compared to normal sinus rhythm or atrial fibrillation affect cardiac reverse remodeling and pacemaker dependency in patients after the Maze procedure?

Population

319 patients undergoing the Maze procedure who maintained a consistent rhythm without crossover from 1 to 12…

Comparison

Junctional rhythm (JR) vs Normal sinus rhythm and Atrial fibrillation

Design

Cohort

Follow-up

12 months

Key result

Junctional rhythm after the Maze procedure failed to achieve cardiac reverse remodeling, demonstrating significantly worse left atrial contractile strain compared to normal sinus rhythm.

Authors

HLHee Jeong LeeYBYohan BaeJWJung Uk Woo

Discussion

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Overview

Hypothesis-generating for NSR-associated remodeling; leaves open causal effects on outcomes without RCTs.

Key Points

  • This study aims to compare the hemodynamic outcomes of junctional rhythm and sinus rhythm following the Maze procedure.
  • Retrospective analysis of patients undergoing the Maze procedure from 2012 to 2024.
  • Included patients with consistent rhythm for 12 months, categorizing them into AF, NSR, and JR groups.
  • Outcomes measured included left atrial contractile strain and chamber dimensions.
  • NSR group showed significant cardiac reverse remodeling with improved LVEF (58.5%) and reduced LA volume index (75.1 mL/m²).
  • JR group displayed no reverse remodeling or mechanical recovery, akin to AF group.
  • JR group had a significantly higher risk of permanent pacemaker implantation (P < 0.001) compared to NSR and AF groups.

Study Design

Type

Cohort (n=319)

Multicenter

No

Structured PICO

Does junctional rhythm compared to normal sinus rhythm or atrial fibrillation affect cardiac reverse remodeling and pacemaker dependency in patients after the Maze procedure?

P
Population
319 adult patients who underwent the Maze procedure for atrial fibrillation and maintained a consistent rhythm, followed for a median of 56 months.
E
Exposure
Junctional rhythm (JR)
C
Comparator
Normal sinus rhythm (NSR) and Atrial fibrillation (AF)
O
Outcome
Cardiac reverse remodeling (assessed by left atrial contractile strain [LASct] and chamber dimensions) and permanent pacemaker (PPM) implantationsurrogate

Main Result

Absolute Event Rate: -1.9% vs -3.3%

p-value: p=0.02

Junctional rhythm after the Maze procedure is not a benign alternative to sinus rhythm, as it prevents cardiac reverse remodeling similarly to atrial fibrillation and carries a high risk of pacemaker dependency.

Limitations

  • Retrospective, single-center design limits generalizability
  • Strict inclusion of rhythm-stable patients may introduce selection bias
  • Residual confounding from unmeasured variables cannot be excluded despite IPTW
  • Small junctional rhythm group size (n=35) limits statistical power for MACE outcomes
  • Inability to fully distinguish sick sinus syndrome and atrial standstill
  • Potential influence of pacing on echocardiographic measurements in patients who received a permanent pacemaker

Cite This Study

Lee et al. (2026) conducted a cohort in Atrial fibrillation (n=319). Junctional rhythm vs. Normal sinus rhythm was evaluated on Left atrial contractile strain (LASct) at 1 year (p=0.02). Junctional rhythm after the Maze procedure failed to achieve cardiac reverse remodeling, demonstrating significantly worse left atrial contractile strain compared to normal sinus rhythm.

synapsesocial.com/papers/6a630201395161722cd166c9https://doi.org/10.1186/s13019-026-04550-7
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