title: The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients.
abstract: OBJECTIVE
  The Cox-maze III procedure (CMP) has achieved high success rates for the surgical treatment of atrial fibrillation (AF). In 2002, our group introduced a simplified CMP, in which most incisions were replaced with linear lines of ablation using bipolar radiofrequency and cryoenergy. This operation, termed the CMP-IV, has significantly shortened operative times and allowed for a minimally invasive approach. This report evaluates our results in 100 consecutive patients undergoing a stand-alone CMP-IV.
  
  
  METHODS
  Data were collected prospectively on 100 patients (mean age, 56 ± 10 years) who underwent a CMP-IV from January 2002 through May 2010. All patients were available for follow-up with a mean follow-up of 17 ± 10 months. Electrocardiograms or 24-h Holter monitorings were obtained at 6, 12, and 24 months. Data were analyzed using a longitudinal database containing over 380 variables.
  
  
  RESULTS
  Thirty-one percent of patients had paroxysmal AF, with the remainder having persistent (6%) or longstanding persistent AF (63%). The mean preoperative duration of AF was 7.4 ± 6.7 years. The mean left atrial diameter was 4.7 ± 1.1 cm. In this group, 40 patients had failed with a mean of 2.6 ± 1.3 catheter ablations. Mean aortic cross-clamp time was 41 ± 13 min. There was one postoperative mortality. Postoperative freedom from AF was 93%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF off antiarrhythmic medication was 82%, 82%, and 84% at 6, 12, and 24 months, respectively.
  
  
  CONCLUSIONS
  The less invasive CMP-IV has a high single procedure success rate, even with improved follow-up and stricter definitions of failure.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Timo
authors.initials: T
authors.lastname: Weimar
authors.forename: Marci S
authors.initials: MS
authors.lastname: Bailey
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Donna
authors.initials: D
authors.lastname: Marin
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schuessler
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D011182:Postoperative Care; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome