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Ann Thorac Surg 2006;81:1773-1779
© 2006 The Society of Thoracic Surgeons
a Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
b Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Accepted for publication October 10, 2005.
* Address correspondence to Dr Van Gelder, Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, the Netherlands (Email: i.c.van.gelder{at}thorax.umcg.nl).
BACKGROUND: Rhythm control is indicated for patients suffering from symptomatic atrial fibrillation (AF), but remains difficult to establish. We investigated the long-term outcome of Cox maze III surgery in patients with symptomatic lone AF refractory to antiarrhythmic drug therapy.
METHODS: Patients with a history of symptomatic paroxysmal or persistent AF refractory for at least two class I or III antiarrhythmic drugs and without structural heart disease or bradyarrhythmias were included. All patients underwent Cox maze III surgery. Complete success was defined as the absence of AF without antiarrhythmic drugs beyond 3 months after the procedure, and partial success as the absence of AF with antiarrhythmic drug use.
RESULTS: A total of 29 patients were included (27 male), with a mean age of 48 ± 6 years. At the time of surgery, 11 patients (38%) had persistent AF. After a mean follow-up of 4.8 ± 2.4 years, 79% of patients had complete success, and 2 patients (7%) were free of AF with antiarrhythmic drugs. At the end of follow-up, left ventricular fractional shortening was significantly improved (from 31% ± 10% to 39% ± 8%, p = 0.002), left atrial size was unchanged, exercise capacity was within normal ranges, and quality of life was comparable with that of healthy controls. Severe complications included reoperations for postoperative bleeding (n = 3), pericardial effusion (n = 1), and mediastinitis (n = 1). In 2 patients, a pacemaker was implanted postoperatively because of sinus node dysfunction.
CONCLUSIONS: Cox maze III surgery is a highly effective therapy for drug-refractory lone AF, and therefore remains an alternative to transvenous pulmonary vein ablation.
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