Acquired: Arrhythmias
Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting

Read at the 42nd Annual Meeting of The Western Thoracic Surgical Association, Waikoloa, Hawaii, June 22-25, 2016.
https://doi.org/10.1016/j.jtcvs.2016.12.034Get rights and content
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Abstract

Objective

Most patients with atrial fibrillation (AF) undergoing cardiac surgery do not receive concomitant ablation. This study reviewed outcomes of patients with AF undergoing Cox-maze IV (CMIV) procedure with radiofrequency and cryoablation and coronary artery bypass grafting (CABG) at our institution.

Methods

Between the introduction of radiofrequency ablation in 2002 and 2015, 135 patients underwent left- or biatrial CMIV with CABG. Patients undergoing other cardiac procedures, except mitral valve repair, or who had emergent, reoperative, or off-pump procedures were excluded. Eighty-three patients remained in the study group after exclusion criteria were applied. Freedom from atrial tachyarrhythmias (ATAs) was ascertained using electrocardiogram, Holter monitor, or pacemaker interrogation at 1 to 5 years postoperatively.

Results

Operative mortality was 3%. Freedom from ATAs at 1 year in the CMIV group was 98%, with 88% off antiarrhythmia drugs. Freedom from ATAs and antiarrhythmia drugs was 70% at 5 years.

Conclusions

The addition of CMIV to CABG resulted in excellent freedom from ATAs at 1 to 5 years. These patients are at increased risk for nonfatal complications compared with others undergoing concomitant surgical ablation.

Key Words

atrial fibrillation
arrhythmia therapy
ablation
coronary artery bypass grafting

Abbreviations and Acronyms

AAD
anti-arrhythmia drugs
AC
anticoagulation
AF
atrial fibrillation
ATA
atrial tachyarrhythmias
CMIV
Cox-maze IV
CABG
coronary artery bypass grafting
STS
Society of Thoracic Surgeons

Cited by (0)

M.R.S. is supported by National Institutes of Health grant No. T32-HL007776. R.J.D. is supported by National Institutes of Health grant No. R01-HL032257.