Key result
Concomitant Cox-Maze IV ablation achieves ~76% freedom from atrial arrhythmias at 12 months in non-paroxysmal AF.
Why the study?
Concomitant surgical ablation of AF improves clinical outcomes, but the efficacy and safety of irrigated radiofrequency ablation and cryoablation for non-paroxysmal AF required evaluation.
Does a Cox-Maze IV lesion set using irrigated radiofrequency and cryoablation improve freedom from atrial arrhythmias in patients with non-paroxysmal atrial fibrillation undergoing concomitant cardiac surgery?
Cohort (n=94)
Yes
Does a Cox-Maze IV lesion set using irrigated radiofrequency and cryoablation improve freedom from atrial arrhythmias in patients with non-paroxysmal atrial fibrillation undergoing concomitant cardiac surgery?
Answers are grounded in this paper and cite their sources.
Concomitant surgical ablation using irrigated radiofrequency and cryoablation during cardiac surgery achieved a 76.2% freedom from atrial arrhythmias at 12 months with a 7.5% major adverse event rate.
OBJECTIVE: Concomitant surgical ablation of atrial fibrillation (AF) improves AF-free survival, decreases stroke risk, and improves quality of life (QOL). This clinical trial evaluated the efficacy and safety of irrigated radiofrequency (iRF) ablation and cryoablation for the treatment of non-paroxysmal AF (NPAF). METHODS: In this prospective, multicenter study, a Cox-Maze IV lesion set using iRF and cryoablation was performed to treat NPAF in patients undergoing concomitant cardiac surgery. Pulmonary vein isolation (PVI) was assessed intraoperatively. The primary efficacy endpoint was freedom from AF/atrial flutter/atrial tachycardia (ATAs) of ≥30 seconds after a 90-day washout from antiarrhythmic drugs (AADs) through 12 months. The primary safety endpoint was the rate of major adverse events (MAEs) at 30 days/discharge. MAEs and rhythm assessments were adjudicated independently. RESULTS: Among 94 treated patients, mean age was 69±7 years, and 33 (35%) patients were female. Fifty-one patients (54%) had persistent AF, and 43 (46%) had long-standing persistent AF. PVI was confirmed in 100% of patients tested (65/65). Freedom from ATAs through 12 months was 76.2% (64/84; 95% Bayesian credible interval: 66.0%-84.0%). Seven of 93 patients 7.5% (95% BCI: 3.75%-14.7%) had 10 MAEs through 30 days. The ≤30-day mortality rate was 4% (2%-11%). QOL scores at 12 months (n=81) improved significantly from baseline (p<0.001). CONCLUSIONS: This trial showed a high rate of success at restoring sinus rhythm with a low complication rate and an improvement in QOL when treating NPAF with iRF clamps and cryoablation. These excellent results support wider adoption of concomitant AF ablation.
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Damiano et al. (2026) conducted a cohort in Non-paroxysmal atrial fibrillation (n=94). Cox-Maze IV lesion set using irrigated radiofrequency (iRF) ablation and cryoablation was evaluated on Freedom from AF/atrial flutter/atrial tachycardia (ATAs) of ≥30 seconds after a 90-day washout from antiarrhythmic drugs (AADs) through 12 months (95% CI 66.0%-84.0%). Concomitant Cox-Maze IV ablation using irrigated radiofrequency and cryoablation achieved 76.2% freedom from atrial arrhythmias at 12 months in non-paroxysmal AF.
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