Abstract 4308: The Outcomes of the Cox-Maze Procedure Following Failed Catheter Ablation: A Multicenter Study
The Cox-Maze procedure (CMP) was introduced over 20 years ago for the surgical treatment of lone atrial fibrillation (AF). In recent years, catheter ablation has become increasingly utilized to treat AF. This has led to a number of patients being referred for surgery following previously failed catheter-based interventions. However, there has been little data documenting outcome of surgical ablation in these patients. The objective of this study was to determine the effectiveness and safety of the CMP after failed catheter ablation. A retrospective review was performed of 49 patients (mean age: 54 ±8 years) who underwent the CMP for lone AF following failed left atrial (LA) catheter ablation (mean: 2.3 ±1.2 ablations) from March 1997 through May 2008 at three institutions. Forty (82%) patients were male. The mean duration of AF was 9 ±7 years (range: 2–28 years). Fifty-nine percent of patients had paroxysmal and 41% had persistent or permanent AF. The mean time between the last catheter ablation and the CMP was 16 ±14 months. The mean LA diameter was 4.5 ±1.1 cm. All patients in this series underwent a full biatrial lesion set, with exclusion of the left atrial appendage. Patients had followup at 3, 6 and 12 months with EKG or Holter monitoring. Mean follow-up was 1.3 ±1.1 years. The operative mortality was 2% (1/49). Median hospital length of stay was 6 days. At 6 months, freedom from atrial tachyarrhythmias (ATAs) was 90% (27/30), with 83% of patients both free from arrhythmias and off all antiarrhythmic drugs. Of the three failures, 2 patients had atrial tachycardia and 1 patient atrial flutter. At 12 months, 88% of patients were free from ATAs, with 74% of patients off antiarrhythmic drugs. Thirty-two percent of patients were still on Coumadin. There have been no late strokes. The Cox-Maze procedure has excellent success in patients who have failed catheter ablation, with the majority of patients off antiarrhythmic drugs by 6 months. In patients who fail catheter ablation and remain symptomatic, surgery should be considered as an option.