title: Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: mid-term results in one hundred consecutive patients.
abstract: OBJECTIVE
  The Cox-Maze procedure was introduced nearly two decades ago for the surgical treatment of atrial fibrillation (AF). Recently, our group has replaced most of the incisions of the Cox-Maze procedure with bipolar radiofrequency (RF) ablations (Cox-Maze IV procedure). The purpose of this study was to examine our midterm results with the Cox-Maze procedure using bipolar RF ablation.
  
  
  METHODS
  From January 2002 to October 2005, 100 consecutive patients underwent a modified Cox-Maze procedure with bipolar RF ablation for AF; 32 were lone operations, and 68 were concomitant procedures. Follow-up was performed at 1, 3, 6, and 12 months, and then annually thereafter. Heart rhythm was confirmed by electrocardiography.
  
  
  RESULTS
  The mean age of patients was 62+/-13 years; 57% were male. Duration of AF was 6.3+/-7.6 years (0.1 to 40 years), 59% had paroxysmal AF, and 34% had permanent AF. Follow-up was complete for all patients with a mean follow-up of 13+/-10 months. At 12-month follow-up, 91% (49/54) of patients were free of AF. Cross-clamp time in the lone Cox-Maze IV procedure patients was 42+/-15 minutes, while it was 101+/-29 minutes for the Cox-Maze IV with a concomitant procedure (compared to 93+/-34 minutes and 122+/-37 minutes for the traditional procedure, P<0.05). There were four operative deaths.
  
  
  CONCLUSIONS
  The Cox-Maze IV procedure had good mid-term efficacy. The use of bipolar RF energy significantly decreased operative time and simplified the procedure compared to the traditional Cox-Maze procedure, potentially increasing utilization of the procedure among cardiac surgeons.
authors.affiliation: Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, MO 63110, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Melby
authors.forename: S P
authors.initials: SP
authors.lastname: Kaiser
authors.forename: M S
authors.initials: MS
authors.lastname: Bailey
authors.forename: A
authors.initials: A
authors.lastname: Zierer
authors.forename: R K
authors.initials: RK
authors.lastname: Voeller
authors.forename: S C
authors.initials: SC
authors.lastname: Lall
authors.forename: N
authors.initials: N
authors.lastname: Munfakh
authors.forename: M R
authors.initials: MR
authors.lastname: Moon
authors.forename: R J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents