{
  "abstract": "Background\n\nSurgical success after the Maze procedure is conventionally defined as \"freedom from atrial fibrillation (AF),\" often grouping junctional rhythm (JR) with normal sinus rhythm (NSR). However, the specific hemodynamic impact of JR remains poorly understood. This study investigated whether JR truly represents a successful outcome compared to NSR and AF.Methods\n\nWe retrospectively analyzed patients undergoing the Maze procedure (2012-2024). After designating the first postoperative month as a blanking period for rhythm instability, we included only patients maintaining a consistent rhythm without crossover from 1 to 12 months postoperatively: AF (n = 71), NSR (n = 213), and JR (n = 35). Outcomes included cardiac reverse remodeling-assessed by left atrial contractile strain (LASct) and chamber dimensions-and permanent pacemaker (PPM) implantation.Results\n\nIn the IPTW-adjusted cohort, the NSR group achieved significant cardiac reverse remodeling, characterized by improved LVEF (58.5%), reduced LA volume index (75.1 mL/m²), and notable recovery of LASct. In stark contrast, the JR group failed to show any reverse remodeling or mechanical recovery, exhibiting hemodynamic stagnation indistinguishable from the AF group. Consequently, no significant difference in cardiac function was observed between the JR and AF groups. Furthermore, the JR group faced a drastically elevated risk of PPM implantation compared to both the NSR and AF groups (P < 0.001).Conclusions\n\nJR is not a benign alternative to sinus rhythm; it mimics AF in preventing cardiac reverse remodeling and carries a high risk of pacemaker dependency. Therefore, JR should be clinically differentiated from NSR and recognized as a suboptimal hemodynamic outcome similar to AF.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea.",
    "Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, 42601, Republic of Korea.",
    "Medical Course, School of Medicine, Keimyung University College of Medicine, Daegu, Republic of Korea.",
    "Department of Emergency Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea.",
    "Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, 42601, Republic of Korea. chest.songks@gmail.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hee Jeong Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "YoHan Bae"
    },
    {
      "affs": [
        2
      ],
      "name": "Jung Uk Woo"
    },
    {
      "affs": [
        1
      ],
      "name": "Sungsil Yoon"
    },
    {
      "affs": [
        1
      ],
      "name": "Woo Sung Jang"
    },
    {
      "affs": [
        1
      ],
      "name": "Yun Seok Kim"
    },
    {
      "affs": [
        3
      ],
      "name": "Jonghoon Yoo"
    },
    {
      "affs": [
        4
      ],
      "name": "Kyungsub Song"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a33vxcbtvqff1.bib",
  "cited_by": 0,
  "doi": "10.1186/s13019-026-04550-7",
  "fulltext_url": "https://europepmc.org/articles/PMC13679280",
  "id": "a33vxcbtvqff1",
  "issns": [
    "1749-8090"
  ],
  "landing_url": "https://europepmc.org/article/MED/42894221",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RD1-811"
    ],
    [
      "lcc",
      "RD78.3-87.3"
    ],
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      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
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  "pdf_url": "https://europepmc.org/articles/PMC13679280?pdf=render",
  "pmcid": "PMC13679280",
  "pmid": "42894221",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/a33vxcbtvqff1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:42Z",
      "native_id": "MED:42894221",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42894221"
    },
    {
      "first_seen": "2026-10-30T13:46:23Z",
      "native_id": "7bff95ae1190413a8940367fb4291887",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s13019-026-04550-7"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.",
  "title_text": "Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:23Z",
  "url": "https://research.draconitic.com/paper/a33vxcbtvqff1",
  "venue": "Journal of cardiothoracic surgery",
  "versions": []
}