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

摘要

PatientsStatistical AnalysisDiscussionReferencesThis 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.MethodsSince 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.ResultsLone 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, 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 antiarrhythmics 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).ConclusionsPatients 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.Abbreviations and Acronyms: AF (atrial fibrillation), ATA (atrial tachyarrhythmia), CI (confidence interval), CMIII (Cox-Maze III), CMIV (Cox-Maze IV), IABP (intraaortic balloon pump), LA (left atrial), LVEF (left ventricular ejection fraction), MV (mitral valve), NYHA (New York Heart Association), OR (odds ratio), PM (pacemaker)CTSNet classification:24, 35Ms Bailey discloses that she has a financial relationship with AtriCure Inc; Dr Schuessler with AtriCure, Inc, Medtronic, Inc, and Estech; Dr Damiano with AtriCure Inc, Medtronic Inc, and ATS Medical; and Dr Maniar with nContact Surgical and Estech.The Cox-Maze (CM) procedure, created by Dr James Cox, was initially designed to treat atrial fibrillation (AF) in patients with mitral valve (MV) disease. However, because initial iterations of the CM procedure were complex, technically difficult, and time consuming, the procedure was preferentially performed as a stand-alone procedure on patients with lone AF [