The Prognostic Scoring System Establishment and Validation for Chronic Atrial Fibrillation Patients Receiving Modified Cox-Maze IV and Concomitant Cardiac Surgery

• Published in: PloS one Vol. 10; no. 6; p. e0126300
• Main Authors: Tsai, Feng-Chun, Ho, Heng-Tsan, Chang, Jen-Ping, Tsai, Feng-Chang, Chu, Jaw-Ji, Lin, Pyng-Jing
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.06.2015; Public Library of Science (PLoS)
• Subjects: Ablation (Surgery); Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Function; Cardiac arrhythmia; Cardiac patients; Cardiac Surgical Procedures - methods; Cardiovascular disease; Care and treatment; Catheters; Conversion; Coronary artery disease; Demographic variables; Demographics; Demography; Electrocardiography; Female; Fibrillation; Heart; Heart Atria - physiopathology; Heart Atria - surgery; Heart diseases; Heart surgery; Hospitals; Humans; Invasiveness; Male; Markers; Medicine; Middle Aged; Morbidity; Patients; Prognosis; Radio frequency; Radiofrequency ablation; Retrospective Studies; ROC Curve; Success; Surgery; Treatment Outcome; Validation Studies as Topic; Vascular surgery; Veins & arteries; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0126300

Traditional Cox maze III is the gold standard for treatment of atrial fibrillation (AF). Because of its invasiveness, it has been replaced by a simplified procedure involving radiofrequency ablation of modified Cox maze IV. Although the modified Cox maze IV has the advantages of simplicity and less morbidity, a lower rate of sinus rhythm conversion has been reported. We try to establish a scoring system to predict the outcome of this procedure. The derivation group consisted of 287 patients with structural heart disease and chronic AF who underwent cardiac surgery and modified Cox-maze IV procedure between August 2005 and March 2013. Demographics, clinical and laboratory variables were retrospectively collected as sinus conversional predictors. Overall sinus conversion rate was 75.8%. The parameters of the Soft Markers Scoring system included AF duration, preoperative left atrial (LA) size, rheumatic pathology and postoperative LA remodeling. We compared 80 patients from another hospital between January 2004 and December 2011 as a validation group to evaluate the power of the scoring system. Soft Markers Score indicated a good discriminative power by using the areas under the receiver operating characteristic curve (AUROC: 0.759 ± 0.032). The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively. In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.