The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients

• Published in: Journal of interventional cardiac electrophysiology Vol. 31; no. 1; pp. 47 - 54
• Main Authors: Weimar, Timo, Bailey, Marci S., Watanabe, Yoshiyuki, Marin, Donna, Maniar, Hersh S., Schuessler, Richard B., Damiano, Ralph J.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2011; Springer Nature B.V
• Subjects: Adult; Aged; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac Pacing, Artificial; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiology; Female; Follow-Up Studies; Humans; Intensive Care Units; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - mortality; Postoperative Care; Stroke - etiology; Treatment Outcome; Arrhythmia; Ablation; Atrial fibrillation; Cox-maze procedure; Surgery
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-011-9547-3

Purpose The Cox-maze III procedure (CMP) has achieved high success rates for the surgical treatment of atrial fibrillation (AF). In 2002, our group introduced a simplified CMP, in which most incisions were replaced with linear lines of ablation using bipolar radiofrequency and cryoenergy. This operation, termed the CMP-IV, has significantly shortened operative times and allowed for a minimally invasive approach. This report evaluates our results in 100 consecutive patients undergoing a stand-alone CMP-IV. Methods Data were collected prospectively on 100 patients (mean age, 56 ± 10 years) who underwent a CMP-IV from January 2002 through May 2010. All patients were available for follow-up with a mean follow-up of 17 ± 10 months. Electrocardiograms or 24-h Holter monitorings were obtained at 6, 12, and 24 months. Data were analyzed using a longitudinal database containing over 380 variables. Results Thirty-one percent of patients had paroxysmal AF, with the remainder having persistent (6%) or longstanding persistent AF (63%). The mean preoperative duration of AF was 7.4 ± 6.7 years. The mean left atrial diameter was 4.7 ± 1.1 cm. In this group, 40 patients had failed with a mean of 2.6 ± 1.3 catheter ablations. Mean aortic cross-clamp time was 41 ± 13 min. There was one postoperative mortality. Postoperative freedom from AF was 93%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF off antiarrhythmic medication was 82%, 82%, and 84% at 6, 12, and 24 months, respectively. Conclusion The less invasive CMP-IV has a high single procedure success rate, even with improved follow-up and stricter definitions of failure.