Intraoperative modified Cox mini-maze procedure for long-standing persistent atrial fibrillation

Area of Science:

• Cardiovascular Surgery
• Electrophysiology
• Minimally Invasive Cardiac Procedures

Background:

• The classic Maze III procedure is highly effective for curing atrial fibrillation but is complex.
• Minimally invasive approaches are needed to overcome the limitations of traditional Maze procedures.
• Radiofrequency ablation offers a potential alternative for atrial fibrillation treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified Cox mini-Maze procedure.
• To assess outcomes for patients with long-standing persistent atrial fibrillation undergoing open-heart surgery.
• To compare the modified procedure with the traditional Cox Maze III in terms of freedom from atrial fibrillation.

Main Methods:

• A modified Cox mini-Maze procedure using radiofrequency energy was performed on 45 patients.
• Unipolar and bipolar radiofrequency systems were utilized for ablation.
• Epicardial and endocardial lesions were created to ensure transmurality.

Main Results:

• Hospital mortality was 0% with 100% survival rate at follow-up (mean 16.6 months).
• Overall freedom from atrial fibrillation was 86.7%, with 94% at 6 months and 82% at 24 months.
• No significant difference in freedom from atrial fibrillation was observed compared to the Cox Maze III control group; 94.6% recovered atrial contractility.

Conclusions:

• The modified Cox mini-Maze procedure is a safe and effective treatment for long-standing persistent atrial fibrillation.
• This technique allows for rapid ablation and promotes recovery of sinus rhythm.
• The procedure offers an optimistic outcome for patients undergoing open-heart surgery.