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Ann Thorac Surg 2008;85:1283-1289. doi:10.1016/j.athoracsur.2007.12.037
© 2008 The Society of Thoracic Surgeons
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Xu Meng
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Original Articles: Adult Cardiac

Intraoperative Modified Cox Mini-Maze Procedure for Long-Standing Persistent Atrial Fibrillation

Yong Qiang Cui, MD, PhD, Ling Bo Sun, MD, PhD, Yan Li, MD, Chun Lei Xu, MD, Jie Han, MD, Hui Li, MD, Xu Meng, MD*

Atrial Fibrillation Center, Anzhen Hospital, Beijing, China

Accepted for publication December 11, 2007.

* Address correspondence to Dr Meng, Department of Cardiac Surgery, Anzhen Hospital, Beijing, 100029, China (Email: mxu{at}263.net).

Background: As the most effective method of curing atrial fibrillation, the classic Maze III procedure eliminates atrial fibrillation in more than 90% of patients. In spite of high efficacy, the complexity and complications associated with this procedure prevents widespread application. In this research, we report our experience with a modified Cox mini-Maze procedure using radiofrequency energy for treating long-standing persistent atrial fibrillation during open-heart surgery.

Methods: A total of 45 patients with long-standing persistent atrial fibrillation who underwent open-heart surgery received the treatment. This modified Cox mini-Maze procedure was performed using unipolar and bipolar radiofrequency systems. Some lesions were done with unipolar pen both epicardially and endocardially to improve the transmurality of ablation.

Results: Hospital mortality was 0%. The follow-up time ranged from 6 to 26 months (mean, 16.6). Overall freedom from atrial fibrillation was 86.7% at latest follow-up after surgery. When analyzed by the Kaplan-Meier method, freedom from atrial fibrillation was 94% (6 months), 87% (12 months), and 82% (24 months). Compared with a randomized Cox Maze III control group, the results of freedom from atrial fibrillation do not show significant differences between the two groups at interval contacts. The survival rate was 100% (45 of 45), as was freedom from stroke. No patients required implantation of a permanent pacemaker. Recovery of atrial contractility occurred in 94.6% of patients (35 of 37) during the latest follow-up.

Conclusions: According to our experience, the modified Cox mini-Maze procedure allows rapid ablation application and offers an optimistic outcome for the recovery of sinus rhythm in patients with long-standing persistent atrial fibrillation who undergo open-heart surgery.






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Copyright © 2008 by The Society of Thoracic Surgeons.