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January 1, 2017Journal of Atrial FibrillationOpen Access

Surgical ablation linked to ~3x greater sinus rhythm maintenance at 2 years vs catheter ablation.

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Why the study?

Do surgical ablation procedures (complete Cox-maze or hybrid maze) improve maintenance of normal sinus rhythm compared to catheter ablation in patients with atrial fibrillation?

Population

140 patients with atrial fibrillation who underwent primary radiofrequency catheter ablation, the complete…

Comparison

Surgical ablation vs Primary radiofrequency catheter ablation

Design

Cohort

Follow-up

2 years

Key result

Surgical treatments, including the hybrid maze (57.9%) and complete Cox-maze (72.7%), were significantly superior to catheter ablation (20.3%) in maintaining normal sinus rhythm at 2 years (p<0.001).

Authors

IGIvo GenevLTLindsey A TompkinsMKManorama M. Khare

Discussion

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Overview

Surgical ablation may improve sinus rhythm maintenance versus catheter ablation; leaves open net benefit given higher complications in non-randomized data.

Study Design

Type

Cohort (n=140)

Multicenter

No

Structured PICO

Do surgical ablation procedures (complete Cox-maze or hybrid maze) improve maintenance of normal sinus rhythm compared to catheter ablation in patients with atrial fibrillation?

P
Population
140 patients with atrial fibrillation undergoing their first invasive rhythm control procedure (catheter ablation, hybrid maze, or complete Cox-maze), followed for 2 years.
I
Intervention
Surgical ablation (complete Cox-maze or hybrid maze)
C
Comparator
Primary radiofrequency catheter ablation
O
Outcome
Maintenance of normal sinus rhythm (arrhythmia recurrence rates)surrogate

Main Result

Absolute Event Rate: 57.9% vs 20.3%

p-value: p=<0.001

Surgical ablation procedures (Cox-maze and hybrid maze) are more effective than catheter ablation at maintaining normal sinus rhythm at 2 years in patients with atrial fibrillation, but are associated with significantly higher major complication rates.

Limitations

  • Single center retrospective analysis of electronic medical records
  • Lack of randomization
  • Limited cohort size, underpowered to detect differences between the two surgical procedures
  • Success based on complete lack of recurrence rather than symptom improvement

Cite This Study

Genev et al. (2017) conducted a cohort in Atrial fibrillation (n=140). Hybrid maze and complete Cox-maze vs. Radiofrequency catheter ablation was evaluated on Normal sinus rhythm at 2 years (p=<0.001). Surgical treatments, including the hybrid maze (57.9%) and complete Cox-maze (72.7%), were significantly superior to catheter ablation (20.3%) in maintaining normal sinus rhythm at 2 years (p<0.001).

synapsesocial.com/papers/6aa77e7afb78d07897effdbehttps://doi.org/10.4022/jafib.1543
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy2015 · 113 citations
  2. 2Staged hybrid totally thoracoscopic maze and catheter ablation for atrial fibrillation2022 · 12 citations
  3. 3A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation2021 · 6 citations
  4. 4Sequential hybrid ablation vs. surgical CryoMaze alone for treatment of atrial fibrillation: results of multicentre randomized controlled trial2024 · 8 citations
  5. 5How does the Cox maze procedure compare? Cost-effectiveness analysis of alternative treatments of atrial fibrillation2018 · 1 citations