Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: mid-term results in one hundred consecutive patients

• Published in: Journal of cardiovascular surgery Vol. 47; no. 6; pp. 705 - 710
• Main Authors: Melby, S J, Kaiser, S P, Bailey, M S, Zierer, A, Voeller, R K, Lall, S C, Munfakh, N, Moon, M R, Damiano, Jr, R J
• Format: Journal Article
• Language: English
• Published: Italy Edizioni Minerva Medica 01.12.2006
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac Surgical Procedures - adverse effects; Catheter Ablation - adverse effects; Catheter Ablation - instrumentation; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Research Design; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 0021-9509; 1827-191X

The Cox-Maze procedure was introduced nearly two decades ago for the surgical treatment of atrial fibrillation (AF). Recently, our group has replaced most of the incisions of the Cox-Maze procedure with bipolar radiofrequency (RF) ablations (Cox-Maze IV procedure). The purpose of this study was to examine our midterm results with the Cox-Maze procedure using bipolar RF ablation. From January 2002 to October 2005, 100 consecutive patients underwent a modified Cox-Maze procedure with bipolar RF ablation for AF; 32 were lone operations, and 68 were concomitant procedures. Follow-up was performed at 1, 3, 6, and 12 months, and then annually thereafter. Heart rhythm was confirmed by electrocardiography. The mean age of patients was 62+/-13 years; 57% were male. Duration of AF was 6.3+/-7.6 years (0.1 to 40 years), 59% had paroxysmal AF, and 34% had permanent AF. Follow-up was complete for all patients with a mean follow-up of 13+/-10 months. At 12-month follow-up, 91% (49/54) of patients were free of AF. Cross-clamp time in the lone Cox-Maze IV procedure patients was 42+/-15 minutes, while it was 101+/-29 minutes for the Cox-Maze IV with a concomitant procedure (compared to 93+/-34 minutes and 122+/-37 minutes for the traditional procedure, P<0.05). There were four operative deaths. The Cox-Maze IV procedure had good mid-term efficacy. The use of bipolar RF energy significantly decreased operative time and simplified the procedure compared to the traditional Cox-Maze procedure, potentially increasing utilization of the procedure among cardiac surgeons.