BACKGROUND: Catheter-based ablation is often recommended for treatment of atrial fibrillation (AF), but there are no data that directly compare late results to those of the Cox-Maze procedure. Although catheter ablation avoids operation, lack of reliable transmurality may reduce effectiveness. We compared clinical outcomes of the cut-and-sew Cox-Maze procedure with catheter ablation. METHODS: Between January 1993 and October 2007, 97 patients aged 25 to 80 years underwent an isolated cut-and-sew Cox-Maze procedure. Patients were matched 1:2 according to age, sex, and AF type, with 194 patients undergoing catheter-based ablation for lone AF. RESULTS: At last follow-up, 82% of patients who underwent the Cox-Maze procedure were free of AF and had stopped taking antiarrhythmic medications compared with 55% of patients who underwent ablation (p<0.001). When analyzed as a time-related event, freedom from recurrent AF was 87% 5 years after the Cox-Maze procedure compared with 28% after catheter ablation (p<0.001). Late warfarin anticoagulation was required in 12% of patients who underwent the Cox-Maze procedure compared with 55% of patients who underwent ablation (p<0.001), and use of antiarrhythmic medications during follow-up was significantly higher in patients who underwent ablation (68% versus 15%, p<0.001). Forty-one patients (24%) required repeated ablation procedure and 9 required a second repeated ablation. CONCLUSIONS: Compared with catheter-based ablation, the Cox-Maze procedure results in greater freedom from AF and less medical treatment with antiarrhythmic drugs and warfarin anticoagulation during follow-up.
BACKGROUND: Catheter-based ablation is often recommended for treatment of atrial fibrillation (AF), but there are no data that directly compare late results to those of the Cox-Maze procedure. Although catheter ablation avoids operation, lack of reliable transmurality may reduce effectiveness. We compared clinical outcomes of the cut-and-sew Cox-Maze procedure with catheter ablation. METHODS: Between January 1993 and October 2007, 97 patients aged 25 to 80 years underwent an isolated cut-and-sew Cox-Maze procedure. Patients were matched 1:2 according to age, sex, and AF type, with 194 patients undergoing catheter-based ablation for lone AF. RESULTS: At last follow-up, 82% of patients who underwent the Cox-Maze procedure were free of AF and had stopped taking antiarrhythmic medications compared with 55% of patients who underwent ablation (p<0.001). When analyzed as a time-related event, freedom from recurrent AF was 87% 5 years after the Cox-Maze procedure compared with 28% after catheter ablation (p<0.001). Late warfarin anticoagulation was required in 12% of patients who underwent the Cox-Maze procedure compared with 55% of patients who underwent ablation (p<0.001), and use of antiarrhythmic medications during follow-up was significantly higher in patients who underwent ablation (68% versus 15%, p<0.001). Forty-one patients (24%) required repeated ablation procedure and 9 required a second repeated ablation. CONCLUSIONS: Compared with catheter-based ablation, the Cox-Maze procedure results in greater freedom from AF and less medical treatment with antiarrhythmic drugs and warfarin anticoagulation during follow-up.
Authors: Jason O Robertson; Phillip S Cuculich; Lindsey L Saint; Richard B Schuessler; Marc R Moon; Jennifer Lawton; Ralph J Damiano; Hersh S Maniar Journal: Ann Thorac Surg Date: 2013-04-30 Impact factor: 4.330
Authors: Deepak K Gupta; Amil M Shah; Robert P Giugliano; Christian T Ruff; Elliott M Antman; Laura T Grip; Naveen Deenadayalu; Elaine Hoffman; Indravadan Patel; Minggao Shi; Michele Mercuri; Veselin Mitrovic; Eugene Braunwald; Scott D Solomon Journal: Eur Heart J Date: 2013-12-02 Impact factor: 29.983