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

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Abstract

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.

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Disclosure

Dr. Damiano is a consultant for AtriCure, Inc. and Medtronic, Inc and has received research grants from AtriCure, Inc., Medtronic, Inc., and Estech. Dr. Schuessler receives research support from AtriCure, Inc., Estech, and Cardialen and serves on the scientific advisory board of Cardialen. Ms. Bailey is a consultant for AtriCure, Inc.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Suite 3108 Queeny Tower, St. Louis, MO, USA

    Timo Weimar, Marci S. Bailey, Yoshiyuki Watanabe, Donna Marin, Hersh S. Maniar, Richard B. Schuessler & Ralph J. Damiano Jr.

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  1. Timo Weimar
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  2. Marci S. Bailey
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  3. Yoshiyuki Watanabe
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  4. Donna Marin
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  5. Hersh S. Maniar
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  6. Richard B. Schuessler
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  7. Ralph J. Damiano Jr.
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Corresponding author

Correspondence to Ralph J. Damiano Jr..

Additional information

This study was funded in part from the National Institute of Health Grants 5RO1 HL032257, RO1 HL085113, and T32 HL07776.

This manuscript was presented at the Sixth International Symposium on Interventional Electrophysiology in the Management of Cardiac Arrhythmias, Newport, Rhode Island, September 24–26, 2010.

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Weimar, T., Bailey, M.S., Watanabe, Y. et al. The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients. J Interv Card Electrophysiol 31, 47–54 (2011). https://doi.org/10.1007/s10840-011-9547-3

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  • DOI: https://doi.org/10.1007/s10840-011-9547-3

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