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J Thorac Cardiovasc Surg 2007;133:1022-1027
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Superiority of cut-and-sew technique for the Cox maze procedure: Comparison with radiofrequency ablation

Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication May 3, 2006; revisions received August 21, 2006; accepted for publication September 8, 2006.

^_* Address for reprints: Hartzell V. Schaff, MD, Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905. (Email: schaff{at}mayo.edu).

Objective: Although radiofrequency ablation is increasingly used to create the atrial lesions of the Cox maze procedure, its effectiveness in ablating atrial fibrillation compared with the standard cut-and-sew method is not known. We compare the freedom from atrial fibrillation in patients undergoing both methods with identical lesion sets.

Methods: Radiofrequency ablation was used to create full Cox maze lesions in 56 patients between January 2002 and February 2005; these patients were matched with those who underwent the standard cut-and-sew method. Matched variables were gender (33 male, 23 female, both), age (67.5 vs 67.2 years), New York Heart Association class (mean 2.28 vs 1.96), atrial fibrillation type (37 paroxysmal, 19 continuous, both), and concomitant mitral valve surgery (37 in both). Hypertension, preoperative left atrial size, and preoperative duration of atrial fibrillation were similar between groups.

Results: When compared with matched controls, fewer patients undergoing radiofrequency ablation were free from atrial fibrillation at dismissal (63% vs 88%; P = .0039) and at last follow-up (62% vs 92%; P = .016). According to logistic regression for matched pairs, patients undergoing radiofrequency ablation were 4.5 times more likely to be in atrial fibrillation at dismissal (95% confidence intervals [CI], 1.8, 10.9) and 5 times more likely to be in atrial fibrillation at follow-up (95% CI, 1.4, 17.3). No other covariate was associated with atrial fibrillation status at hospital dismissal or follow-up.

Conclusion: Creating Cox maze lesions with radiofrequency ablation is associated with less freedom from atrial fibrillation both early and late postoperatively. Because transmurality can be assured, the standard cut-and-sew Cox maze procedure remains the gold standard for the surgical treatment of atrial fibrillation.

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Discussion
J. Thorac. Cardiovasc. Surg. 133: 1027-1027. [Full Text]

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