title: Favorable long-term outcome of Maze surgery in patients with lone atrial fibrillation.
abstract: 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.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Martin E W
authors.initials: ME
authors.lastname: Hemels
authors.forename: Youlan L
authors.initials: YL
authors.lastname: Gu
authors.forename: Anton E
authors.initials: AE
authors.lastname: Tuinenburg
authors.forename: Piet W
authors.initials: PW
authors.lastname: Boonstra
authors.forename: Ans C P
authors.initials: AC
authors.lastname: Wiesfeld
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome; D014463:Ultrasonography