Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: Mid-term results in one hundred consecutive patients

Aim. The Cox-maze procedure was introduced nearly wo decades ago for the surgical treatment of atrial fibrillation (AF). Recently, our group has replaced most of the incisions of the Cox-Maze procedure with bipolar radiofrequency (RF) ablations (Cox-Maze IV procedure). The purpose of this study was to examine our midterm results with the Cox-Maze procedure using bipolar RF ablation. Methods. From January 2002 to October 2005, 100 consecutive patients underwent a modified Cox-Maze procedure with bipolar RF ablation for AF; 32 were lone operations, and 68 were concomitant procedures. Follow-up was performed at 1, 3, 6, and 12 months, and then annually thereafter. Heart rhythm was confirmed by electrocardiography. Results. The mean age of patients was 62±13 years; 57% were male. Duration of AF was 6.3±7.6 years (0.1 to 40 years), 59% had paroxysmal AF, and 34% had permanent AF. Follow-up was complete for all patients with a mean follow-up of 13±10 months. At 12-mondi follow-up, 91% (49/ 54) of patients were free of AF. Cross-clamp time in the lone Cox-Maze IV procedure patients was 42±15 minutes, while it was 101±29 minutes for the Cox-Maze IV with a concomitant procedure (compared to 93±34 minutes and 122±37 minutes for the traditional procedure, P<0.05). There were four operative deaths. Conclusions. The Cox Maze IV procedure had good mid term efficacy. The use of bipolar RF energy significantly decreased operative time and simplified the procedure compared to the traditional Cox-Maze procedure, potentially increasing utilization of the procedure among cardiac surgeons.