Surgery for permanent atrial fibrillation: impact of patient factors and lesion set
Open accessAbstract
Background Whether a complete Cox-maze procedure is needed to ablate permanent atrial fibrillation in patients undergoing concomitant cardiac surgery is unknown. Our objective was to assess the effectiveness of different lesion sets in such patients.Methods From November 1991 to January 2004, 575 patients underwent surgical treatment of permanent atrial fibrillation (duration > 6 months); mitral valve disease was the primary indication for surgery in 74%. Procedures included pulmonary vein isolation alone (n = 68, 12%), pulmonary vein isolation with left atrial connecting lesions (n = 265, 46%), and Cox-maze (n = 242, 42%). Rhythm documented on 5,120 postoperative electrocardiograms was used to estimate time-related prevalence of, and risk factors for, atrial fibrillation.Results Prevalence of postoperative atrial fibrillation peaked at 46% two weeks after operation, declining to 24% at one year. Patient-related risk factors for increased prevalence included older age (p < 0.0001), larger left atrium (p < 0.0001), and longer duration of preoperative atrial fibrillation (p = 0.0008). The Cox-maze procedure and lesion sets resembling it created with alternative energy sources had a similarly low prevalence of late postoperative atrial fibrillation; in contrast, pulmonary vein isolation and lesion sets that did not include a lesion to the mitral anulus were less effective.Conclusions This study suggests that in cardiac surgical patients with permanent atrial fibrillation the left atrial lesion set should include wide pulmonary vein isolation, at least one connection between right and left pulmonary veins, and a connection to the mitral anulus. Availability of alternative energy sources to create lesions sets has virtually eliminated the need for the cut-and-sew Cox-maze procedure.
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Biatrial lesion patterns may be more effective in persistent and long-standing persistent atrial fibrillation.
“Biatrial lesion patterns may be more effective in persistent and long-standing persistent AF. 797,803,806”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [803]
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When Should Prophylactic Maze Procedure Be Considered in Patients Undergoing Mitral Valve Surgery?
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Surgery for Atrial Fibrillation
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Self-citationSurgical ablation for atrial fibrillation
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Permanent Chronic Atrial Fibrillation: Is Pulmonary Vein Isolation Alone Enough?
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- Authors
- Gillinov, A. M., Bhavani, S., Blackstone, E. H., Rajeswaran, J., Svensson, L. G., Navia, J. L., Pettersson, B. G., Sabik, J. F., Smedira, N. G., Mihaljevic, T., McCarthy, P. M., Shewchik, J., & Natale, A.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Gillinov, A. Marc
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2006-08
- Volume
- 82
- Issue
- 2
- Pages
- 502-514
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2070951560
- Cited by
- 203
- References
- 34
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 8 · 2020: 8 · 2019: 4 · 2018: 10 · 2017: 6 · 2016: 13 · 2015: 14 · 2014: 12 · 2013: 20 · 2012: 16
- FWCI
- 10.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- permanent atrial fibrillation, surgical ablation, Cox-Maze procedure, pulmonary vein isolation, mitral valve disease, postoperative atrial fibrillation, risk factors, left atrium size, combined cardiac surgery, alternative energy
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Electrocardiography, Female, Follow-Up Studies, Heart Rate, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Pulmonary Veins, Risk Factors, Catheter Ablation
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