Document Detail

The Cox maze IV procedure: predictors of late recurrence.
MedLine Citation:
PMID:  21168019     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The Cox maze III procedure achieved high cure rates and became the surgical gold standard for the treatment of atrial fibrillation. Because of its invasiveness, a more simplified ablation-assisted procedure, the Cox maze IV procedure, has been performed at our institution since January 2002. The study examined multiple preoperative and perioperative variables to determine predictors of late recurrence.
METHODS: Data were collected prospectively on 282 patients who underwent the Cox maze IV procedure from January 2002 through December 2009. Forty-two percent of patients had paroxysmal and 58% had either persistent or long-standing persistent atrial fibrillation. All patients were available for follow-up. Follow-up included electrocardiograms in all patients. Since 2006, 24-hour Holter monitoring was obtained in 94% of patients at 3, 6, and 12 months. Data were analyzed by means of logistic regression analysis at 12 months, with 13 preoperative and perioperative variables used as covariates.
RESULTS: Sixty-six percent of patients had a concomitant procedure. After an ablation-assisted Cox maze procedure, the freedom from atrial fibrillation was 89%, 93%, and 89% at 3, 6, and 12 months, respectively. The freedom from both atrial fibrillation and antiarrhythmic drugs was 63%, 79%, and 78% at 3, 6, and 12 months, respectively. The risk factors for atrial fibrillation recurrence at 1 year were enlarged left atrial diameter (P = .027), failure to isolate the entire posterior left atrium (P = .022), and early atrial tachyarrhythmias (P = .010).
CONCLUSIONS: The Cox maze IV procedure has a high success rate at 1 year, even with improved follow-up and stricter definitions of failure. In patients with large left atria, there might be a need for more extensive size reduction or expanded lesion sets.
Ralph J Damiano; Forrest H Schwartz; Marci S Bailey; Hersh S Maniar; Nabil A Munfakh; Marc R Moon; Richard B Schuessler
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-13     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  113-21     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation / diagnosis,  surgery*
Catheter Ablation / adverse effects,  methods*
Chi-Square Distribution
Electrocardiography, Ambulatory
Heart Atria / surgery,  ultrasonography
Logistic Models
Middle Aged
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Grant Support
F32 HL082129-02/HL/NHLBI NIH HHS; F32HL082129-02/HL/NHLBI NIH HHS; R01 HL032257/HL/NHLBI NIH HHS; R01 HL032257-21/HL/NHLBI NIH HHS; R01 HL032257-21/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Anti-Arrhythmia Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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