Mid-term outcomes of the modified Cox-maze procedure for elderly patients: a risk analysis for failure

Although the maze procedure is highly effective for most patients with atrial fibrillation (AF), its standardized application to elderly patients is controversial. Between 2004 and 2007, 143 patients with a mean age of 65 years of age or older underwent the modified Cox-maze procedure concomitant with other cardiac procedures. The follow-up data were available from 128 patients, and the mean follow-up period was 37.1 months. The overall sinus rhythm (SR) rate at the latest follow-up was 74.2%. The cumulative freedom from AF without antiarrhythmic medication was 65.2% at five years. Stroke was less prevalent in patients with a stable SR than in those with a recurrence of AF. There were two patients (1.6%) who required permanent pacemaker placement during follow-up. Multivariate analysis demonstrated that a duration of AF >5 years, a fine f-wave and a dimension of the left atrium ≥60 mm were independent risk factors for recurrent AF. The Cox proportional hazard model showed that the former two factors independently affected freedom from recurrence. In conclusion, the modified Cox-maze procedure was safe and beneficial for patients 65 years of age or older, supporting that the limited biatrial ablation might be sufficient for elderly patients without risk factors for recurrence.