Cox-Maze IV Results for Patients With Lone Atrial Fibrillation Versus Concomitant Mitral Disease

Abstract

Background This study compared Cox-Maze IV (CMIV) outcomes for the treatment of atrial fibrillation (AF) in patients with lone AF vs those with AF and mitral valve (MV) disease. Methods Since 2002, 200 patients have undergone a CMIV procedure for lone AF (n = 101) or concomitantly with MV operations (n = 99). Preoperative, perioperative, and late outcomes between these groups were compared. Data were collected prospectively and reported at 3, 6, and 12 months. Results Lone AF patients had AF of longer duration; patients with AF and MV disease were older, with larger left atria and worse New York Heart Association classification (p < 0.05). Operative mortality (1% vs 4%, p > 0.05, respectively) was similar between both groups. Perioperative atrial tachyarrhythmias were more prevalent in patients with concomitant MV operations (57% vs 41%, p = 0.03); however, freedom from AF and antiar-rhythmics was similar for both groups at 12 months (76% and 77%). The only predictor for atrial tachyarrhythmia recurrence or arrhythmic drug dependence was failure to isolate the posterior left atrium (p < 0.01). Conclusions Patients with AF and MV disease have distinct comorbidities compared with patients with lone AF. However, the CMIV is safe and effective in both groups and should be considered for patients with AF undergoing MV operations. Patients with MV disease had more atrial tachyarrhythmias at 3 months, but freedom from AF and antiarrhythmics was similar to patients with lone AF at 1 year. The posterior left atrium should be isolated in every patient, because this was the only predictor for failure of the CMIV for either group.

The ABLATE Trial: Safety and Efficacy of Cox Maze-IV Using a Bipolar Radiofrequency Ablation System

“…In particular, the primary efficacy endpoint, freedom from AF after 6 months without AADs, was achieved in 76% of cases (95% CI: 62.6% to 85.7%). This value is similar to that of major recent CMP-IV clinical trials such as that of Damiano and colleagues [13] (282 patients, 79%) and Saint and associates [14] (100 concomitant CMP-IV patients, 77%).…”

“…For example, freedom from AF at 6 months with AADs is 84.0% (95% CI: 71.5% to 91.7%). This is lower than, but not significantly different from, Saint and associates [14] (100 concomitant CMP-IV patients, 91%, p ¼ 0.204 with a two-proportion z-test), but significantly different from Damiano and associates [13] (93%, p ¼ 0.037 with a two-proportion z-test). Freedom from AF at 21 months was reached by 75% with AADs and by 62.5% without AADs.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…dwubiegunowa ablacja RF lub kriotermia) sprawia, że zabiegi labiryntowania Cox-Maze są łatwiejsze, bardziej powtarzalne i możliwe z dostępu przez minitorakotomię [786,807,808]. Torakoskopowa PVI za pomocą dwubiegunowej ablacji RF zapobiega nawrotom AF (odsetek pacjentów bez arytmii w rocznej obserwacji 69-91%, układ wykonywanych uszkodzeń -patrz ryc.…”

Biatrial ablation versus limited right atrial ablation for atrial fibrillation associated with atrial septal defect in adults

“…after the cox-Maze III procedure was introduced in 1988, it was considered the "gold standard" to eliminate aF, but it is an extremely complex procedure, also called the 'cut-andsew-Maze' [4,5]. Instead of using incisions, the surgical radiofrequency ablation maze procedure is a mini maze procedure, which uses radiofrequency energy to scar the tissue and create a conduction block to stop errant electrical signals [16][17][18][19]. In this study, a bipolar rF ablation clamp was used in all patients, which had a higher rate of transmurality and was more effective than unipolar devices.…”