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Efficacy of the Stand-Alone Cox-Maze IV Procedure in Patients with Longstanding Persistent Atrial Fibrillation
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  • Martha McGilvray,
  • Nadia Bakir,
  • Meghan Kelly,
  • Samuel Perez,
  • Laurie Sinn,
  • Richard Schuessler,
  • Christian Zemlin,
  • Hersch Maniar,
  • Spencer Lelby,
  • Ralph Damiano
Martha McGilvray
Washington University in St Louis School of Medicine

Corresponding Author:[email protected]

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Nadia Bakir
Washington University in St Louis School of Medicine
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Meghan Kelly
Washington University in St Louis School of Medicine
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Samuel Perez
Washington University in St Louis School of Medicine
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Laurie Sinn
Washington University in St Louis School of Medicine
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Richard Schuessler
Washington University in St Louis School of Medicine
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Christian Zemlin
Washington University in St Louis School of Medicine
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Hersch Maniar
Washington University in St Louis School of Medicine
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Spencer Lelby
Washington University in St Louis School of Medicine
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Ralph Damiano
Washington University in St Louis School of Medicine
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Abstract

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat. Methods & Results: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range [IQR] 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence. Conclusion: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.
25 Feb 2021Submitted to Journal of Cardiovascular Electrophysiology
25 Feb 2021Submission Checks Completed
25 Feb 2021Assigned to Editor
28 Feb 2021Reviewer(s) Assigned
Oct 2021Published in Journal of Cardiovascular Electrophysiology volume 32 issue 10 on pages 2884-2894. 10.1111/jce.15113