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Result of Cox Maze Procedure with Bipolar Radiofrequency Electrode and Cryoablator for Persistent Atrial Fibrillation - Compared with Cut-sew Technique -  

Lee, Mi-Kyung (Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine)
Choi, Jong-Bum (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School)
Lee, Jung-Moon (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School)
Kim, Kyung-Hwa (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School)
Kim, Min-Ho (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School)
Publication Information
Journal of Chest Surgery / v.42, no.6, 2009 , pp. 710-718 More about this Journal
Abstract
Background: The Cox maze procedure has been used as a standard surgical treatment for atrial fibrillation for about 20 years. Recently, the creators have used a bipolar radiofrequency electrode (Cox maze IV procedure) instead of the incision and suture (cut-sew) technique to make atrial ablation lesions for persistent atrial fibrillation. We investigated clinical outcomes for the Cox maze procedure with a bipolar radiofrequency electrode and cryoablator in patients with persistent atrial fibrillation, and compared results with clinical outcomes of the cut-sew procedure. Material and Method: Between April 2005 and July 2007, 40 patients with persistent atrial fibrillation underwent Cox maze IV procedure with a bipolar radiofrequency electrode and cryoablator (bipolar radiofrequency group). Surgical outcomes were compared with those of 35 patients who had the cut-sew technique for the Cox maze III procedure. All patients had concomitant cardiac surgery. Postoperatively, the patients were followed up every 1 to 2 months. Result: At 6 months postoperatively, the conversion rate to regular sinus rhythm was not significantly different between the two groups: 95.0% for the bipolar radiofrequency ablation group; 97.1% for the cut-sew technique (p=1.0). At the end of the follow-up period, the conversion rate to regular sinus rhythm was also not significantly different (92.5% vs. 91.6%, p=1.0). In multivariate analysis using a Cox-regression model, the postoperative atrial dimension was an independent determinant of sinus conversion in the bipolar radiofrequency ablation group (hazard ratio 31, p=0.005). In the Cox-regression model for both groups, atrial fibrillation at 6 months postoperatively (hazard ratio 92.24, p=0.003) and the postoperative left atrial dimension (hazard ratio 16.05, p=0.019) were independent risk factors of continuance or recurrence of atrial fibrillation after Cox maze procedures. Aortic cross-clamp time and cardiopulmonary bypass time were significantly shorter in the radiofrequency group than in the cut-sew group. Conclusion: In the Cox maze procedure for patients with persistent atrial fibrillation, the use of bipolar radiofrequency ablation and a cryoablator is as good as the cut-sew technique for conversion to sinus rhythm. The postoperative left atrial dimension is an independent determinant of postoperative continuance and recurrence of atrial fibrillation.
Keywords
Arrhythmia surgery; Surgical instruments; Outcome assessment;
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Times Cited By KSCI : 2  (Citation Analysis)
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