Abstract | BACKGROUND:
Catheter-based ablation for atrial fibrillation (AF) performed percutaneously is shown to be limited in patients with nonparoxysmal AF (non-PAF). The full Cox-Maze surgical procedure demonstrated good success with non-PAF, but concerns were raised regarding increased morbidity eliminating the effect of the success rate. This study assessed the safety and efficacy of a stand-alone on-pump Cox-Maze procedure for non-PAF. METHODS: Since 2005, 104 stand-alone Cox- Maze procedures for non-PAF were performed through a right minithoracotomy (6 cm) with femoral cannulation. Patients were monitored prospectively through our AF registry. Rhythm was verified by electrocardiogram and 24-hour Holter monitoring. Health-related quality of life (SF-12 Health Survey, Quality Metric, Lincoln, RI) and AF symptoms were assessed. RESULTS: Patients were a mean age of 55.9±9.0 years, and 78% had long-standing persistent AF. Patient outcomes included no operative (30 days) deaths or renal failure, 1 pacemaker, and 1 transient ischemic attack. The return to sinus rhythm at 6, 12, 24, 36 months was 94%, 94%, 92%, 92%, and off antiarrhythmic drugs was 87%, 87%, 79%, 80%, respectively. The success rate at 6 months after the initial 20 patients improved from 89% to 94%. Multivariate analysis found duration of AF predicted rhythm at 6 months (odds ratio, 1.15; 95% confidence interval, 1.01 to 1.31; p=0.04). Significant improvement was noted for health-related quality of life and decreased AF symptoms at 1 year. CONCLUSIONS: The long-term success rate after the Cox-Maze III procedure in a challenging group of non-PAF patients is acceptable. Our experience suggests the development of educational strategies to overcome the initial learning curve and patient selection criteria for AF surgical ablation.
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Authors | Niv Ad, Linda Henry, Ted Friehling, Marc Wish, Sari D Holmes |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 96
Issue 3
Pg. 792-8; discussion 798-9
(Sep 2013)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 23891410
(Publication Type: Journal Article)
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Copyright | Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Atrial Fibrillation
(diagnosis, mortality, surgery)
- Cardiac Surgical Procedures
(methods, mortality)
- Cohort Studies
- Confidence Intervals
- Cryosurgery
(methods, mortality)
- Electrocardiography
(methods)
- Electrocardiography, Ambulatory
(methods)
- Female
- Follow-Up Studies
- Hospital Mortality
(trends)
- Humans
- Male
- Middle Aged
- Minimally Invasive Surgical Procedures
(methods, mortality)
- Multivariate Analysis
- Odds Ratio
- Postoperative Complications
(mortality, physiopathology)
- Quality of Life
- Registries
- Risk Assessment
- Severity of Illness Index
- Survival Rate
- Tachycardia, Paroxysmal
- Treatment Outcome
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