Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery

Abstract

For selected patients with a history of AF undergoing cardiac surgery, concomitant CM4 did not add significantly to postoperative morbidity or mortality and was associated with improved late survival compared with patients with untreated AF and a similar survival to patients without a history of AF.

Patient Selection for Epicardial Ablation—Part I: The Role of Epicardial Ablation in Various Cardiac Disease States

“…57 A single-center, propensity-matched study reported 10-year survival rates in patients following Cox maze IV and those with untreated AF of 62% and 42%, respectively. 58 In a collaboration between cardiothoracic surgeons and electrophysiologists, percutaneous endocardial catheter mapping and ablation were first added to epicardial thorascopic ablation with the hope of increasing the success rates by combining potential advantages of each separate procedure. 59 This hybrid AF procedure allowed for fast epicardial placement of extensive linear lesions with the endovascular validation of complete bidirectional conduction block.…”

Noninvasive Electrocardiographic Imaging: A Novel Tool for Understanding Atrial Fibrillation in Candidates for Cardiac Surgery?

“…Nevertheless, the anatomical approach of the Cox maze procedure, whether performed as the original "cut-and-sew" technique or by using different ablative energy sources, has been associated with the highest long-term success rate. 3 Experimental as well as clinical data suggest that focal as well as rotational drivers in both atria may be critical and responsible for maintaining AF. [4][5][6] Noninvasive phase mapping is a relatively new tool that allows high-resolution simultaneous recording of biatrial AF activation sequences under circumstances close to normal physiological conditions.…”

Commentary: Questionable statistical routines

“…4 Considering the paper by Malaisrie and colleagues, 2 the data set might have been addressed in multiple different ways, including an overall Cox model, but the authors rejected this suggestion. Especially since the Malaisrie data are at variance with so many other studies showing a consistent treatment effect (Figure 2), 1,[6][7][8] Cox regression analysis of the primary overall data might have been useful. Finally, the average patient in this study was operated more than a decade ago, and one half were earlier than that.…”

“…Propensity-matched Kaplan-Meier survival curves between isolated CABG þ ablation versus isolated CABG alone. B, Recent data from Washington University 8. Kaplan-Meier curves showing survival of the matched CM4 and Untreated AF groups.…”