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. 2011 Jan;141(1):113-21.
doi: 10.1016/j.jtcvs.2010.08.067.

The Cox maze IV procedure: predictors of late recurrence

Ralph J Damiano Jr  1 , Forrest H Schwartz, Marci S Bailey, Hersh S Maniar, Nabil A Munfakh, Marc R Moon, Richard B Schuessler
Affiliations

The Cox maze IV procedure: predictors of late recurrence

Ralph J Damiano Jr et al. J Thorac Cardiovasc Surg. 2011 Jan.

Abstract

Objectives: The Cox maze III procedure achieved high cure rates and became the surgical gold standard for the treatment of atrial fibrillation. Because of its invasiveness, a more simplified ablation-assisted procedure, the Cox maze IV procedure, has been performed at our institution since January 2002. The study examined multiple preoperative and perioperative variables to determine predictors of late recurrence.

Methods: Data were collected prospectively on 282 patients who underwent the Cox maze IV procedure from January 2002 through December 2009. Forty-two percent of patients had paroxysmal and 58% had either persistent or long-standing persistent atrial fibrillation. All patients were available for follow-up. Follow-up included electrocardiograms in all patients. Since 2006, 24-hour Holter monitoring was obtained in 94% of patients at 3, 6, and 12 months. Data were analyzed by means of logistic regression analysis at 12 months, with 13 preoperative and perioperative variables used as covariates.

Results: Sixty-six percent of patients had a concomitant procedure. After an ablation-assisted Cox maze procedure, the freedom from atrial fibrillation was 89%, 93%, and 89% at 3, 6, and 12 months, respectively. The freedom from both atrial fibrillation and antiarrhythmic drugs was 63%, 79%, and 78% at 3, 6, and 12 months, respectively. The risk factors for atrial fibrillation recurrence at 1 year were enlarged left atrial diameter (P = .027), failure to isolate the entire posterior left atrium (P = .022), and early atrial tachyarrhythmias (P = .010).

Conclusions: The Cox maze IV procedure has a high success rate at 1 year, even with improved follow-up and stricter definitions of failure. In patients with large left atria, there might be a need for more extensive size reduction or expanded lesion sets.

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Figures

Figure 1
Figure 1
a. Right atrial lesion set of the Cox-Maze IV procedure b. Left atrial lesion set of the Cox-Maze IV procedure
Figure 2
Figure 2
Freedom from atrial tachyarrhythmias with and without antiarrhythmic drugs at 3, 6, and 12 months with number of patients at risk.
Figure 3
Figure 3
Relationship between left atrial size and probability of atrial fibrillation recurrence
See this image and copyright information in PMC

References

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