{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:51:09Z","timestamp":1790178669710,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,10,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              To characterize the development of sick sinus syndrome (\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              ) after the additive maze procedure (\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              ) during mitral valve surgery.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Follow\u2010up data (median, 3.6\u00a0years) of 750 patients with a prevalence of rheumatic cause of 57.6% were analyzed.\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              occurred in 35 patients with a time\u2010dependent increase: the incidence rates at 1, 2, and 4\u00a0years after surgery were 2.9%, 3.7%, and 4.3%, respectively. The additive\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              showed higher risks of\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              development (hazard ratio, 7.44; 95% confidence interval, 3.45\u201316.05;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and pacemaker implantation (hazard ratio, 3.61; 95% confidence interval, 1.95\u20136.67;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Patients who developed\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              showed higher 4\u2010year rates of clinical events (death, stroke, and hospital admission) (67.5\u00b18.5% versus 33.0\u00b11.9%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After adjustment for age and preoperative peak systolic pulmonary artery pressure, the lesion extent (biatrial versus left atrial\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              ), not the underlying cause (rheumatic versus nonrheumatic), was independently associated with\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              development (hazard ratio, 3.58; 95% confidence interval, 1.08\u201311.86;\n              <jats:italic>P<\/jats:italic>\n              =0.037). The adverse effect of the biatrial\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              was confirmed in patients with trivial or mild preoperative tricuspid regurgitation showing higher\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              incidence (4.6\u00b11.4% versus 1.0\u00b10.7%;\n              <jats:italic>P<\/jats:italic>\n              =0.023), not in those with moderate\u2010to\u2010severe tricuspid regurgitation (6.8\u00b11.7% versus 3.8\u00b13.8%;\n              <jats:italic>P<\/jats:italic>\n              =0.337). Recurrence of atrial fibrillation was not associated with the lesion extent of the\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              After the additive\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              , the ongoing risk of\n              <jats:styled-content style=\"fixed-case\">SSS<\/jats:styled-content>\n              development should be acknowledged irrespective of the underlying cause. Considering additive risk of biatrial\n              <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>\n              with similar atrial fibrillation recurrence rate, minimizing lesion extent is warranted.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009629","type":"journal-article","created":{"date-parts":[[2018,9,29]],"date-time":"2018-09-29T18:24:25Z","timestamp":1538245465000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery"],"prefix":"10.1161","volume":"7","author":[{"given":"Min Soo","family":"Cho","sequence":"first","affiliation":[{"name":"Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul 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