ReviewEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2018
The Cox-maze IV procedure in its second decade: still the gold standard?
Review in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 1 synthesis or guideline pooled it, 92 citations in OpenAlex.
- Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis.Journal of cardiothoracic surgery · 2023Pooled it
- Persistent atrial fibrillation without the evidence of low-voltage areas: a prospective randomized trial.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Trial
- Multicenter randomized study evaluating the outcome of ganglionated plexi ablation in maze procedure.General thoracic and cardiovascular surgery · 2022Trial
- Left Atrial Appendage Aneurysm and Atrial Fibrillation: A Case Report of Surgical Resection and Ablation.JACC. Case reports · 2026Article
- Initial experiences of surgical left atrial maze through resected left atrial appendage.General thoracic and cardiovascular surgery · 2026Article
- Long-term outcomes of one-stop unilateral thoracoscopic hybrid ablation for persistent atrial fibrillation after failed catheter ablation.Journal of cardiothoracic surgery · 2026Article
- Adenosine-Sensitive Focal Atrial Tachycardia Late After Atriopulmonary Connection Fontan Procedure: A Case Report.Journal of arrhythmia · 2026Article
- Evolution of Energy Sources in Surgical Ablation of Atrial Fibrillation: Current Technology and Future Directions.Reviews in cardiovascular medicine · 2026Review
- The effect of non-insulin dependent insulin resistance indices on the prediction in the recurrence of late atrial fibrillation after modified maze procedure concomitant with valvular heart surgery.BMC cardiovascular disorders · 2025Article
- Surgical Methods and Devices for Atrial Fibrillation.Reviews in cardiovascular medicine · 2025Review
- High incidence of permanent pacemaker after Cox-maze IV and mitral valve surgery: a nationwide registry-based study.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Article
- The cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with atrial fibrillation undergoing valvular replacement and Cox maze III procedure.Journal of cardiothoracic surgery · 2025Article
- Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Tailored bi-atrial linear ablation guided by electrophysiological mapping for persistent atrial fibrillation.BMC cardiovascular disorders · 2024Article
- Outcomes of surgical ablation for atrial fibrillation in on- versus off-pump coronary artery bypass grafting.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Computational modeling of cardiac electrophysiology and arrhythmogenesis: toward clinical translation.Physiological reviews · 2024Review
- Surgical ablation of atrial fibrillation during mitral valve surgery: a systematic review and meta-analysis.Annals of cardiothoracic surgery · 2024Article
- Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation.Frontiers in cardiovascular medicine · 2024Article
- Trends in surgical ablation at the time of cardiac surgery among patients with atrial fibrillation.JTCVS open · 2023Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and the treatment options include medical treatment and catheter-based or surgical interventions. AF is a major cause of stroke, and its prevalence is increasing. The surgical treatment of AF has been revolutionized over the past 2 decades through surgical innovation and improvements in endoscopic imaging, ablation technology and surgical instrumentation. The Cox-maze (CM) procedure, which was developed by James Cox and introduced clinically in 1987, is a procedure in which multiple incisions are created in both the left and the right atria to eliminate AF while allowing the sinus impulse to reach the atrioventricular node. This procedure became the gold standard for the surgical treatment of AF. Its latest iteration is termed the CM IV and was introduced in 2002. The CM IV replaced the previous cut-and-sew method (CM III) by replacing most of the incisions with a combination of bipolar radiofrequency and cryoablation. The use of ablation technologies, made the CM IV technically easier, faster and more amenable to minimally invasive approaches. The aims of this article are to review the indications and preoperative planning for the CM IV, to describe the operative technique and to review the literature including comparisons of the CM IV with the previous cut-and-sew method. Finally, this review explores future directions for the surgical treatment of patients with AF.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.