title: Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting.
abstract: Most patients with atrial fibrillation (AF) undergoing cardiac surgery do not receive concomitant ablation. This study reviewed outcomes of patients with AF undergoing Cox-maze IV (CMIV) procedure with radiofrequency and cryoablation and coronary artery bypass grafting (CABG) at our institution.
  
  
  
  Between the introduction of radiofrequency ablation in 2002 and 2015, 135 patients underwent left- or biatrial CMIV with CABG. Patients undergoing other cardiac procedures, except mitral valve repair, or who had emergent, reoperative, or off-pump procedures were excluded. Eighty-three patients remained in the study group after exclusion criteria were applied. Freedom from atrial tachyarrhythmias (ATAs) was ascertained using electrocardiogram, Holter monitor, or pacemaker interrogation at 1 to 5 years postoperatively.
  
  
  
  Operative mortality was 3%. Freedom from ATAs at 1 year in the CMIV group was 98%, with 88% off antiarrhythmia drugs. Freedom from ATAs and antiarrhythmia drugs was 70% at 5 years.
  
  
  
  The addition of CMIV to CABG resulted in excellent freedom from ATAs at 1 to 5 years. These patients are at increased risk for nonfatal complications compared with others undergoing concomitant surgical ablation.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Schill
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Farah N
authors.initials: FN
authors.lastname: Musharbash
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Vivek
authors.initials: V
authors.lastname: Hansalia
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Greenberg
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Sinn
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schuessler
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo. Electronic address: damianor@wustl.edu.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077982:Progression-Free Survival; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation; arrhythmia therapy; atrial fibrillation; coronary artery bypass grafting