Result of Cox Maze Procedure with Bipolar Radiofrequency Electrode and Cryoablator for Persistent Atrial Fibrillation: Compared with Cut-sew Technique.
- Author:
Mi Kyung LEE
1
;
Jong Bum CHOI
;
Jung Moon LEE
;
Kyung Hwa KIM
;
Min Ho KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Korea.
- Publication Type:Original Article
- Keywords:
Arrhythmia surgery;
Surgical instruments;
Outcome assessment
- MeSH:
Atrial Fibrillation;
Cardiopulmonary Bypass;
Electrodes;
Follow-Up Studies;
Humans;
Multivariate Analysis;
Recurrence;
Risk Factors;
Surgical Instruments;
Sutures;
Thoracic Surgery
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2009;42(6):710-718
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The Cox maze procedure has been used as a standard surgical treatment for atrial fibrillation for about 20 years. Recently, the creators have used a bipolar radiofrequency electrode (Cox maze IV procedure) instead of the incision and suture (cut-sew) technique to make atrial ablation lesions for persistent atrial fibrillation. We investigated clinical outcomes for the Cox maze procedure with a bipolar radiofrequency electrode and cryoablator in patients with persistent atrial fibrillation, and compared results with clinical outcomes of the cut-sew procedure. MATERIAL AND METHOD: Between April 2005 and July 2007, 40 patients with persistent atrial fibrillation underwent Cox maze IV procedure with a bipolar radiofrequency electrode and cryoablator (bipolar radiofrequency group). Surgical outcomes were compared with those of 35 patients who had the cut-sew technique for the Cox maze III procedure. All patients had concomitant cardiac surgery. Postoperatively, the patients were followed up every 1 to 2 months. RESULT: At 6 months postoperatively, the conversion rate to regular sinus rhythm was not significantly different between the two groups: 95.0% for the bipolar radiofrequency ablation group; 97.1% for the cut-sew technique (p=1.0). At the end of the follow-up period, the conversion rate to regular sinus rhythm was also not significantly different (92.5% vs. 91.6%, p=1.0). In multivariate analysis using a Cox-regression model, the postoperative atrial dimension was an independent determinant of sinus conversion in the bipolar radiofrequency ablation group (hazard ratio 31, p=0.005). In the Cox-regression model for both groups, atrial fibrillation at 6 months postoperatively (hazard ratio 92.24, p=0.003) and the postoperative left atrial dimension (hazard ratio 16.05, p=0.019) were independent risk factors of continuance or recurrence of atrial fibrillation after Cox maze procedures. Aortic cross-clamp time and cardiopulmonary bypass time were significantly shorter in the radiofrequency group than in the cut-sew group. CONCLUSION: In the Cox maze procedure for patients with persistent atrial fibrillation, the use of bipolar radiofrequency ablation and a cryoablator is as good as the cut-sew technique for conversion to sinus rhythm. The postoperative left atrial dimension is an independent determinant of postoperative continuance and recurrence of atrial fibrillation.
