title: Minimally invasive stand-alone Cox-maze procedure for patients with nonparoxysmal atrial fibrillation.
abstract: BACKGROUND
  Catheter-based ablation for atrial fibrillation (AF) performed percutaneously is shown to be limited in patients with nonparoxysmal AF (non-PAF). The full Cox-Maze surgical procedure demonstrated good success with non-PAF, but concerns were raised regarding increased morbidity eliminating the effect of the success rate. This study assessed the safety and efficacy of a stand-alone on-pump Cox-Maze procedure for non-PAF.
  
  
  METHODS
  Since 2005, 104 stand-alone Cox-Maze procedures for non-PAF were performed through a right minithoracotomy (6 cm) with femoral cannulation. Patients were monitored prospectively through our AF registry. Rhythm was verified by electrocardiogram and 24-hour Holter monitoring. Health-related quality of life (SF-12 Health Survey, Quality Metric, Lincoln, RI) and AF symptoms were assessed.
  
  
  RESULTS
  Patients were a mean age of 55.9±9.0 years, and 78% had long-standing persistent AF. Patient outcomes included no operative (30 days) deaths or renal failure, 1 pacemaker, and 1 transient ischemic attack. The return to sinus rhythm at 6, 12, 24, 36 months was 94%, 94%, 92%, 92%, and off antiarrhythmic drugs was 87%, 87%, 79%, 80%, respectively. The success rate at 6 months after the initial 20 patients improved from 89% to 94%. Multivariate analysis found duration of AF predicted rhythm at 6 months (odds ratio, 1.15; 95% confidence interval, 1.01 to 1.31; p=0.04). Significant improvement was noted for health-related quality of life and decreased AF symptoms at 1 year.
  
  
  CONCLUSIONS
  The long-term success rate after the Cox-Maze III procedure in a challenging group of non-PAF patients is acceptable. Our experience suggests the development of educational strategies to overcome the initial learning curve and patient selection criteria for AF surgical ablation.
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Virginia 22042, USA. niv.ad@inova.org
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
authors.forename: Linda
authors.initials: L
authors.lastname: Henry
authors.forename: Ted
authors.initials: T
authors.lastname: Friehling
authors.forename: Marc
authors.initials: M
authors.lastname: Wish
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D003452:Cryosurgery / Q000379:methods / Q000401:mortality; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013614:Tachycardia, Paroxysmal; D016896:Treatment Outcome
keywords: 24