title: Intermediate-term outcomes of surgical atrial fibrillation correction with the CryoMaze procedure.
abstract: BACKGROUND
  Few studies have reported long-term outcomes of surgical atrial fibrillation (AF) correction. We perform the Cox-Maze III lesion set with argon-powered cryoenergy (CryoMaze procedure) on all patients with AF presenting for cardiac operations. This study reports long-term clinical results and heart rhythm status.
  
  
  METHODS
  Between July 2002 and November 2005, 119 consecutive patients underwent surgical AF correction with the CryoMaze procedure. Mitral valve disease was the primary indication for operation in 66%. AF was continuous in 65%. Rhythm assessment was with 2-week continuous electrocardiographic (ECG) monitoring in 75% of patients and by noncontinuous ECG in the remainder. Median follow-up was 3.2 years and was 98% complete.
  
  
  RESULTS
  There was one hospital (0.8%) death. Survival at 3 years was 84%. One perioperative stroke resolved completely. No late strokes occurred. In 4 of 119 patients (4 (3.4%), pacemakers were inserted during the index hospitalization. Median length of stay was 7 days. Overall freedom from AF more than 3 years after operation was 60%. Among patients with preoperative intermittent AF, 85% (28 of 33) were in normal sinus rhythm, and 47% (27 of 58) with continuous AF were in normal sinus rhythm (p < 0.001).
  
  
  CONCLUSIONS
  CryoMaze AF correction is safe and is associated with a very low risk of stroke. Rates of normal sinus rhythm at more than 3 years postoperatively were high for patients with intermittent AF and acceptable for those with continuous AF. This experience supports wider application of the CryoMaze to all patients with AF who need cardiac operations.
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jgammie@smail.umaryland.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: Parijat
authors.initials: P
authors.lastname: Didolkar
authors.forename: Leandra S
authors.initials: LS
authors.lastname: Krowsoski
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Santos
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Toran
authors.forename: Cindi A
authors.initials: CA
authors.lastname: Young
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Shorofsky
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vander Salm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery*; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult