Abstract
Atrial fibrillation (AF) may be associated with significant morbidity and mortality, which are directly related to its detrimental sequelae: significant symptoms, tachycardia-induced cardiomyopathy, and systemic thromboembolism. In recent years, symptomatic patients are being referred to have either catheter-based ablation or surgical ablation. In this report, the history, results, and predictors for failure of the Cox-Maze procedure and its modifications are discussed.
Similar content being viewed by others
References
Cox, J. L., Boineau, J. P., Schuessler, R. B., et al. (1996). Elecrophysiologic basis, surgical development and clinical results of the maze procedure for atrial flutter and atrial fibrillation. In R. B. Karp & A. S. Wechsler (Eds.), Advances in cardiac surgery 1995, vol 6 (p. 1). St. Louis: Mosby-Year Book.
Queiroga, A., Marshall, H. J., Clune, M., & Gammage, M. D. (2003). Ablate and pace revisited: Long-term survival and predictors of permanent atrial fibrillation. Heart, 89(9), 1035–1038.
Boineau, J. P., Mooney, C., Hudson, R., et al. (1977). Observation on reentrant excitation pathways and refaractory period distribution in spontaneous and experimental atrial flutter in dog. In H. E. Kulbertus (Ed.), Re-entrant Arrhythmias (pp. 79–98). Baltimore, MD: University Park Press.
Smith, P. K., Holman, W. L., & Cox, J. L. (1985). Surgical treatment of supraventricular tachyarrhythmias. Surgical Clinics of North America, 65, 553–570.
Boineau, J. P., Schuessler, R. B., Mooney, C., et al. (1980). Natural and evoked atrial flutter due to circus movement in dogs. American Journal of Cardiology, 45, 1167–1181.
D’ Agostino, H. J. Jr., Harada, A., Schuessler, R. B., et al. (1987). Global epicardial mapping of atrial fibrillation in a canine model of chronic mitral regurgitation. Circulation, 76, IV–165.
Yamaguchi, S., Sato, S., Schuessler, R. B., et al. (1990). Induced atrial arrhythmias in a canine model of left atrial enlargement. Pacing and Clinical Electrophysiology, 13, 556.
Cox, J. L., Schuessler, R. B., D’Agostino, H. J. Jr., et al. (1991). The surgical treatment of atrial fibrillation: III Development of a definite surgical procedure. Journal of Thoracic Cardiovascular Surgery, 101, 569–583.
Canavan, T. E., Schuessler, R. B., Cain, M. E., et al. (1988). Computerized global electrophysiological mapping of the atrium in a patient with multiple supraventricular arrhythmias. Annals of Thoracic Surgery, 46, 223–231.
Cox, J. L., Canavan, T. E., Schuessler, R. B., et al. (1991). The surgical treatment of atrial fibrillation II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 101, 406–426.
Cox, J. L. (1991). The surgical treatment of atrial fibrillation: IV. Surgical technique. Journal of Thoracic Cardiovascular Surgery, 101, 584–592.
Cox, J. L., Boineau, J. P., Schuessler, R. B., et al. (1995). Modifications of the Maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. Journal of Thoracic Cardiovascular Surgery, 110, 473–483.
Cox, J. L., Jaquiss, R. D., Schuessler, R. B., et al. (1995). Modifications of the Maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the Maze III procedure. Journal of Thoracic Cardiovascular Surgery, 110, 485–495.
McCarthy, P. M., Gillinov, A. M., Castle, L., Chung, M., & Cosgrove, D. III. (2000). The Cox-Maze procedure: the Cleveland Clinic experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 25–29.
Schaff, H. V., Dearani, J. A., Daly, R. C., Orszulak, T. A., & Danielson, G. K. (2000). Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 30–37.
Arcidi, J. M. Jr., Doty, D. B., & Millar, R. C. (2000). The Maze procedure: the LDS Hospital experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 38–43.
Kosakai, Y. (2000). Treatment of atrial fibrillation using the Maze procedure: the Japanese experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 44–52.
Damiano, R. J. Jr., Gaynor, S. L., Bailey, M., Prasad, S., Cox, J. L., Boineau, J. P., et al. (2003). The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. Journal of Thoracic Cardiovascular Surgery, 126, 2016–2021.
Prasad, S. M., Maniar, H. S., Camillo, C. J., Schuessler, R. B., Boineau, J. P., Sundt, T. M. III, et al. (2003). The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. Journal of Thoracic Cardiovascular Surgery, 126, 1822–1828.
Ballaux, P. K. E. W., Geuzebroek, G. S. C., van Hemel, N. M., Kelder, J. C., Dossche, K. M. E., Ernst, J. M. P. G., et al. (2006). Freedom from atrial arrhythmias after classic maze III surgery: A 10-year experience. Journal of Thoracic Cardiovascular Surgery, 132, 1433–1440.
Bando, K., Kobayashi, J., Sasako, Y., Tagusari, O., Niwaya, K., & Kitamura, S. (2002). Effect of maze procedure in patients with atrial fibrillation undergoing valve replacement. Journal of Heart Valve Disease, 11(5), 719–724.
Ad, N., Cox, J. L., Palazzo, T. L., Kim, Y. D., Syderhoud, J. P., Degroot, K. W., et al. (2000). Stroke prevention as an indication for the Maze procedure in the treatment of atrial fibrillation. Seminars in Thoracic Cardiovascular Surgery, 12, 56–62.
Cox, J. L., Schuessler, R. B., Lappas, D. G., et al. (1996). An 8.5 year clinical experience with surgery for atrial fibrillation. Annals of Surgery, 224(3), 267–275.
Kim, K. C., Cho, K. R., Kim, Y. J., Sohn, D. W., Kim, K. B. (2007). Long-term results of the Cox-Maze III procedure for persistent atrial fibrillation associated with rheumatic mitral valve disease: 10-year experience. European Journal of Cardio-Thoracic Surgery, 31(2), 261–266.
Gillinov, A. M., Bhavani, S., Blackstone, E. H., Rajeswaran, J., Svensson, L. G., Navia, J. L., et al. (2006). Atrial fibrillation: impact of patient factors and lesion set. Annals of Thoracic Surgery, 82(2), 502–513.
Gaynor, S. L., Schuessler, R. B., Bailey, M. S., Ishii, Y., Boineau, J. P., Gleva, M. J., et al. (2005). Surgical treatment of atrial fibrillation: predictors of late recurrence. Journal of Thoracic and Cardiovascular Surgery, 129(1), 104–111.
Kawaguchi, A. T., Kosakai, Y., Isobe, F., Sasako, Y., Eishi, K., Nakano, K., et al. (1996). Factors affecting rhythm after the maze procedure for atrial fibrillation. Circulation, 94(9 Suppl), II139–II142.
Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339(10), 659–666.
Nademanee, K., McKenzie, J., Kosar, E., et al. (2004). A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. Journal of the American College of Cardiology, 43, 2044–2053.
Schmitt, C., Ndrepepa, G., Weber, S., Schmieder, S., Weyerbrock, S., Schneider, M., et al. (2002). Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation. American Journal of Cardiology, 89(12), 1381–1387.
Cox, J. L., & Ad, N. (2000). New surgical and catheter-based modifications of the Maze procedure. Seminars in Thoracic Cardiovascular Surgery, 12(1), 68–73.
Cox, J. L., & Ad, N. (1999). The minimally invasive maze procedure. Circulation, 100(Suppl I), 732 (abstract).
Khargi, K., Deneke, T., Haardt, H., Lemke, B., Grewe, P., Muller, K. M., et al. (2001). Saline-irrigated, cooled-tip radiofrequency ablation is an effective technique to perform the maze procedure. Annals of Thoracic Surgery, 72(3), S1090–S1095.
Gillinov, A. M., McCarthy, P. M., Blackstone, E. H., Rajeswaran, J., Pettersson, G., Sabik, J. F., et al. (2005). Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. Journal of Thoracic Cardiovascular Surgery, 129(6), 1322–1329.
Kabbani, S. S., Murad, G., Jamil, H., Sabbagh, A., & Hamzeh, K. (2005). Ablation of atrial fibrillation using microwave energy–early experience. Asian Cardiovascular and Thoracic Annals, 13(3), 247–250.
Garrido, M. J., Williams, M., & Argenziano, M. (2004). Minimally invasive surgery for atrial fibrillation: toward a totally endoscopic, beating heart approach. Journal of Cardiac Surgery, 19(3), 216–220.
Mack, C. A., Milla, F., Ko, W., Girardi, L. N., Lee, L. Y., Tortolani, A. J., et al. (2005). Surgical treatment of atrial fibrillation using argon-based cryoablation during concomitant cardiac procedures. Circulation, 112(9 Suppl), I1–I6.
Ninet, J., Roques, X., Seitelberger, R., Deville, C., Pomar, J. L., Robin, J., et al. (2005). Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: Results of a multicenter trial. Journal of Thoracic Cardiovascular Surgery, 130(3), 803.e1.
Viola, N., Williams, M. R., & Oz, M. C. (2002). The technology in use for the surgical ablation of atrial fibrillation. Seminars in Thoracic Cardiovascular Surgery, 14, 198–205.
Damiano, R. J. Jr. (2003). Alternative energy sources for atrial ablation: judging the new technology. Annals of Thoracic Surgery, 75(2), 329–330.
Ad, N. The Cryosurgical maze procedure. Adult expert technique at CTSNet, at http://www.ctsnet.org/sections/clinicalresources/adultcardiac/expert_tech-5.html.
Saltman, A. E., Rosenthal, L. S., Francalancia, N. A., & Lahey, S. J. (2003). A completely endoscopic approach to microwave ablation for atrial fibrillation. Heart Surgery Forum, 6(3), E38–E41.
Wolf, R. K., Schneeberger, E. W., Osterday, R., Miller, D., Merrill, W., Flege, J. B. Jr., et al. (2005). Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 130, 797–802.
Barnett, S. D., & Ad, N. (2006). Surgical ablation as treatment for the elimination of atrial fibrillation: A meta-analysis. Journal of Thoracic Cardiovascular Surgery, 131, 1029–1035.
Nitta, T., Ohmori, H., Sakamoto, S., Miyagi, Y., Kanno, S., & Shimizu, K. (2003). Map-guided surgery for atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 129, 291–299.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ad, N. The Cox-Maze procedure: History, results, and predictors for failure. J Interv Card Electrophysiol 20, 65–71 (2007). https://doi.org/10.1007/s10840-007-9176-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-007-9176-z