Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.
5 affiliations
- 1Department of Cardiology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea.
- 2Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, 42601, Republic of Korea.
- 3Medical Course, School of Medicine, Keimyung University College of Medicine, Daegu, Republic of Korea.
- 4Department of Emergency Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea.
- 5Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, 42601, Republic of Korea. [email protected].
Abstract
Background
Surgical 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
We 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
In 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
JR 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.
Related
- Malignant remodeling of the bone marrow microenvironment in acute myeloid leukemia: mechanisms and therapeutic implications
- B-cell receptor repertoire remodeling in Kawasaki disease is associated with clonal expansion and distinct repertoire features in coronary artery lesions
- Pan-cancer remodeling of reactive oxygen species homeostasis: distinct roles of the ROS-generation and antioxidant arms in immune context and outcome
- Dynamic Urothelial Remodeling in Diabetic Bladder Dysfunction: Disease-Course Changes, Molecular Mechanisms, and Clinical Implications
- Aldosterone-Mediated Atrial Remodeling and Atrial Fibrillation: Molecular Mechanisms, Translational Insights and Implications for Cardiac Surgery
BibTeX
@article{lee2026distinct,
title = {{Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.}},
author = {Hee Jeong Lee and YoHan Bae and Jung Uk Woo and Sungsil Yoon and Woo Sung Jang and Yun Seok Kim and Jonghoon Yoo and Kyungsub Song},
journal = {Journal of cardiothoracic surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04550-7},
url = {https://europepmc.org/article/MED/42894221},
note = {CC BY},
}
RIS
TY - JOUR
TI - Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.
AU - Hee Jeong Lee
AU - YoHan Bae
AU - Jung Uk Woo
AU - Sungsil Yoon
AU - Woo Sung Jang
AU - Yun Seok Kim
AU - Jonghoon Yoo
AU - Kyungsub Song
PY - 2026
DA - 2026/07/01
JO - Journal of cardiothoracic surgery
DO - 10.1186/s13019-026-04550-7
UR - https://europepmc.org/article/MED/42894221
AB - Background Surgical 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 We 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 In 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 JR 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.
SN - 1749-8090
ER -