Cox-maze IV results for patients with lone atrial fibrillation versus concomitant mitral disease

Lindsey L. Saint, Marci S. Bailey, Sunil Prasad, Tracey J. Guthrie, Jennifer Bell, Marc R. Moon, Jennifer S. Lawton, Nabil A. Munfakh, Richard B. Schuessler, Ralph J. Damiano, Hersh S. Maniar

Research output: Contribution to journalArticlepeer-review


Background: This study compared Cox-Maze IV (CMIV) outcomes for the treatment of atrial fibrillation (AF) in patients with lone AF vs those with AF and mitral valve (MV) disease. Methods: Since 2002, 200 patients have undergone a CMIV procedure for lone AF (n = 101) or concomitantly with MV operations (n = 99). Preoperative, perioperative, and late outcomes between these groups were compared. Data were collected prospectively and reported at 3, 6, and 12 months. Results: Lone AF patients had AF of longer duration; patients with AF and MV disease were older, with larger left atria and worse New York Heart Association classification (p < 0.05). Operative mortality (1% vs 4%, p > 0.05, respectively) was similar between both groups. Perioperative atrial tachyarrhythmias were more prevalent in patients with concomitant MV operations (57% vs 41%, p = 0.03); however, freedom from AF and antiarrhythmics was similar for both groups at 12 months (76% and 77%). The only predictor for atrial tachyarrhythmia recurrence or arrhythmic drug dependence was failure to isolate the posterior left atrium (p < 0.01). Conclusions: Patients with AF and MV disease have distinct comorbidities compared with patients with lone AF. However, the CMIV is safe and effective in both groups and should be considered for patients with AF undergoing MV operations. Patients with MV disease had more atrial tachyarrhythmias at 3 months, but freedom from AF and antiarrhythmics was similar to patients with lone AF at 1 year. The posterior left atrium should be isolated in every patient, because this was the only predictor for failure of the CMIV for either group.

Original languageEnglish (US)
Pages (from-to)789-795
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number3
StatePublished - Mar 2012
Externally publishedYes


  • AF
  • ATA
  • CI
  • CMIV
  • Cox-Maze III
  • Cox-Maze IV
  • IABP
  • LA
  • LVEF
  • MV
  • NYHA
  • New York Heart Association
  • OR
  • PM
  • atrial fibrillation
  • atrial tachyarrhythmia
  • confidence interval
  • intraaortic balloon pump
  • left atrial
  • left ventricular ejection fraction
  • mitral valve
  • odds ratio
  • pacemaker

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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