The ablation-assisted Cox-Maze IV procedure had significantly shorter cross-clamp times than the original cut-and-sew Cox-Maze III (41 vs 92 minutes; P<0.001) with 90% freedom from AF at 2 years.
Cohort (n=212)
Does the ablation-assisted Cox-Maze IV procedure reduce cross-clamp time and maintain freedom from atrial fibrillation compared to the cut-and-sew Cox-Maze III procedure in patients with lone atrial fibrillation?
The ablation-assisted Cox-Maze IV procedure significantly reduces cross-clamp time compared to the traditional cut-and-sew Cox-Maze III while maintaining high rates of freedom from atrial fibrillation.
Absolute Event Rate: 41% vs 92%
p-value: p=<0.001
BACKGROUND: The Cox-Maze procedure (CMP) has achieved high success rates in the therapy of atrial fibrillation (AF) while becoming progressively less invasive. This report evaluates our experience with the CMP in the treatment of lone AF over 2 decades and compares the original cut-and-sew CMP-III to the ablation-assisted CMP-IV, which uses bipolar radiofrequency and cryoenergy to create the original lesion pattern. METHODS AND RESULTS: Data were collected prospectively on 212 consecutive patients (mean age, 53.5±10.4 years; 78% male) who underwent a stand-alone CMP from 1992 through 2010. The median duration of preoperative AF was 6 (interquartile range, 2.9-11.5) years, with 48% paroxysmal and 52% persistent or long-standing persistent AF. Univariate analysis with preoperative and perioperative variables used as covariates for the CMP-III (n=112) and the CMP-IV (n=100) was performed. Overall, 30-day mortality was 1.4%, with no intraoperative deaths. Freedom from AF was 93%, and freedom from AF off antiarrhythmics was 82%, at a mean follow-up time of 3.6±3.1 years. Freedom from symptomatic AF at 10 years was 85%. Only 1 late stroke occurred, with 80% of patients not receiving anticoagulation therapy. The less invasive CMP-IV had significantly shorter cross-clamp times (41±13 versus 92±26 minutes; P<0.001) while achieving high success rates, with 90% freedom from AF and 84% freedom from AF off antiarrhythmics at 2 years. CONCLUSIONS: The CMP, although simplified and shortened by alternative energy sources, has excellent results, even with improved follow-up and stricter definition of failure.
Weimar et al. (Fri,) conducted a cohort in Lone atrial fibrillation (n=212). Ablation-assisted Cox-Maze procedure (CMP-IV) vs. Original cut-and-sew Cox-Maze procedure (CMP-III) was evaluated on Cross-clamp time (minutes) (p=<0.001). The ablation-assisted Cox-Maze IV procedure had significantly shorter cross-clamp times than the original cut-and-sew Cox-Maze III (41 vs 92 minutes; P<0.001) with 90% freedom from AF at 2 years.