Abstract 18679: Stand Alone Cox-Maze Procedure for Patients with Non Paroxysmal Atrial Fibrillation- A Single Center Experience
Background: Catheter ablation for atrial fibrillation (AF) performed percutaneousely or using minimally invasive (MI) off bypass surgical techniques is shown to be limited in patients with non-paroxysmal AF (non PAF). The Cox-Maze procedure (CM) on bypass is effective in non-PAF patients, but concerns about associated morbidity were raised. The study purpose assesses the safety and efficacy of a stand alone on pump CM procedure in patients with non-PAF.
Methods: Since 2005, 690 patients had surgical ablation at our institution: 175 (25%) referred for stand alone CM procedure; 138 (20%) undergoing a stand alone procedure for non-PAF . All patients are followed prospectively thru our AF registry. Rhythm verified by EKG and 24-hour holter using the Heart Rhythm Society definition of failure. Health-related quality of life (HRQL, SF-12) and AF symptoms assessed preoperatively/12 months post procedure.
Results: Mean age of: 56.9±8.7 years; 60% had at least 1 prior cardioversion and 42% had a catheter ablation; other descriptives and major perioperative morbidities table. The return to sinus rhythm at 6, 12 and 24 months and off antiarrythmic drugs respectively are: 93%/83%; 93%/85%; 90%/79%. In a multivariate analysis, duration of AF predicted rhythm 12 months after surgery, with 20% greater odds of AF at 12 months for each year increase in duration (OR=1.20, CI: 1.03-1.40) after adjustment for other risk factors. By 2 years, only 20% of patients remained on Coumadin with only1 embolic stroke in 44±26 patient months. HRQL significantly improved (p<0.001) and symptoms significantly decreased (p=0.003) by 12 months. By Kaplan-Meier analysis - 97.6% cumulative survival (CI: 95-100%) at 2 years.
Conclusion: On pump stand alone CM procedure can be performed with comparable morbidity to catheter ablation. Long term success in non-PAF patients with large left atria is promising. Our experience suggests development of educational strategies to overcome an initial learning curve.
- © 2012 by American Heart Association, Inc.