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Low Mortality and Low Rate of Perceived and Documented Arrhythmias after Cox Maze III Surgery for Atrial Fibrillation
Author(s) -
JOHANSSON BIRGITTA I.,
VÄÄRT OSKAR,
EDVARDSSON NILS,
NYSTRÖM BRITTA,
SCHERSTÉN HENRIK,
KARLSSON THOMAS,
BERGLIN EVA
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12286
Subject(s) - medicine , atrial fibrillation , concomitant , atrial flutter , hazard ratio , ejection fraction , cardiology , atrial tachycardia , adverse effect , proportional hazards model , tachycardia , refractory (planetary science) , confidence interval , surgery , catheter ablation , heart failure , physics , astrobiology
Background To report a long‐term single‐site experience of the cut‐and‐sew Cox maze III procedure for atrial fibrillation (AF). Methods A total of 232 consecutive patients underwent the Cox maze III procedure for symptomatic therapy‐refractory AF, with concomitant surgery in 34 patients. Follow‐up data were obtained from electrocardiograms, patient visits, questionnaires, and medical files. Results There were 103 patients (44%) with paroxysmal AF during 8.8 ± 6.5 years and 129 patients (56%) with nonparoxysmal AF for 7.3 ± 6.7 years. The preoperative New York Heart Association class was better in patients with paroxysmal AF (P < 0.0001); the left ventricular ejection fraction was 59 ± 7% versus 56 ± 8%, P = 0.003, and the left atrial area 24 ± 6 versus 27 ± 6 cm 2 , P = 0.01. Early and late postoperative adverse events occurred at similar rates. Four patients from each group died of reasons unrelated to surgery. The mean follow‐up was 66 ± 42 (5–155) months. In total, 184/229 (80%) patients were free of documented AF/atrial flutter/atrial tachycardia (AF/AFl/AT) off antiarrhythmic drugs (AA) and 189/229 (83%) on or off AA. The hazard ratio (HR) for paroxysmal versus nonparoxysmal AF patients regarding documented AF/AFl/AT was 0.8 (95% confidence interval [CI] 0.4–1.4; P = 0.40). For patients without versus with concomitant surgery, the corresponding HR was 0.4 (95% CI 0.2–0.8; P = 0.008). Of 197 patients (89%) responding to the questionnaire, 41 had sought care for symptoms of arrhythmia, 29 of whom had documented AF/AFl/AT, whereas another six had other arrhythmias. Conclusion Cut‐and‐sew Cox maze III surgery provided long‐lasting high efficacy, also in patients with nonparoxysmal AF of long duration and/or concomitant surgery, and was associated with low rates of subsequent adverse events.