Experience with Various Surgical Options for the Treatment of Atrial Fibrillation




Background: New alternatives exist using various energy sources and lesion lines for the surgical treatment of atrial fibrillation (AF). The efficacy of these options compared to the cut-and-sew maze III procedure is unknown.

Methods: From August 1996 to August 2003, 79 patients have undergone a procedure for AF, with 70 patients currently more than 3 months postsurgery. The patients (58 continuous, 12 paroxysmal) underwent a surgical procedure for AF, lone AF (12) and with concomitant procedures (58). Techniques included cut and sew (23), bipolar radiofrequency (RF) (28) and unipolar-RF (10), and cryothermy (9). Lesions included maze III (46), pulmonary vein isolation (16), and pulmonary vein isolation plus mitral annular connecting line only (8).

Results: Follow-up was complete in 58 (83%) of 70 patients at a mean time of 595 ± 750 days (range, 24-2530 days). The operative mortality was 0% in lone AF patients and 7.1% (5/70) in patients undergoing concomitant procedures. Need for perioperative pacemaker was 22.9%. Overall, normal sinus rhythm (NSR) was restored in 82.7% of patients, with success in 83.3% (10/12) lone procedures and 82.6% (38/46) concomitant procedures (P = NS); the rate of continuous AF was 85.1% (40/47) and SR with paroxysmal fibrillation was 72.7% (8/11) (P = NS). Traditional maze was successful in 80.6% (29/36) patients, pulmonary vein isolation was successful 93.3% (14/15), and left-sided maze in 71.4% (5/7) (P = NS). Cut and sew procedures were successful in 88.2% (15/17), RF-bipolar in 84.0% (21/25), RF-unipolar in 77.8% (7/9), and cryothermy in 71.4% (5/7) (P = NS). Energy source, lesion set, AF duration, and lone/concomitant procedure were the factors subjected to logistic regression analysis. No factors were predictive of achieving postoperative NSR. Conclusions: Our early experience with newer surgical techniques employing different energy sources and fewer incision lines suggests that the success rate may approach the results obtained with traditional cut-and-sew Cox-maze III procedures.


Wattigney WA, Mensah GA, Croft JB. 2003. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 108:711-6.nDamiano RJ Jr, Gaynor SL, Bailey M, et al. 2003. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the cox maze procedure. J Thorac Cardiovasc Surg 126:2016-21.nDoll N, Kiaii BB, Fabricius AM, et al. 2003. Intraoperative left atrial ablation (for atrial fibrillation) using a new argon cryocatheter: early clinical experience. Ann Thorac Surg 76:1711-5.nFriberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB. 2003. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 14:666-72.nPrasad SM, Maniar HS, Camillo CJ, et al. 2003. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg 126:1822-7.nRaman JS, Ishikawa S, Power JM. 2002. Epicardial radiofrequency ablation of both atria in the treatment of atrial fibrillation: experience in patients. Ann Thorac Surg 74:1506-9.nTsang TS, Petty GW, Barnes ME, et al. 2003. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol 42:93-100.nCox JL. 2003. Atrial fibrillation, II: rationale for surgical treatment. J Thorac Cardiovasc Surg 126:1693-9.nCox JL. 2003. Atrial fibrillation, I: a new classification system. J Thorac Cardiovasc Surg 126:1686-92.nCox JL, Boineau JP, Schuessler RB, Kater KM, Lappas DG. 1993. Five-year experience with the maze procedure for atrial fibrillation. Ann Thorac Surg 56:814-23.nCox JL, Jaquiss RDB, Schuessler RB, Boineau JP. 1995. Modification of the maze procedure for atrial flutter and atrial fibrillation, II: surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 110:485-95.n



How to Cite

Experience with Various Surgical Options for the Treatment of Atrial Fibrillation. (2005). The Heart Surgery Forum, 7(4), E333-E336. https://doi.org/10.1532/HSF98.20041013