ArticleThe Journal of thoracic and cardiovascular surgery2022
The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation.
Article in The Journal of thoracic and cardiovascular surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 2 of them syntheses that pooled it.
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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
54 citing papers in PubMed, 2 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- Concomitant surgical ablation for atrial fibrillation in mitral valve surgery: a systematic review of clinical outcomes and surgical strategies.Frontiers in cardiovascular medicine · 2026Pooled it
- Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis.Journal of cardiothoracic surgery · 2023Pooled it
- Circumferential pulmonary vein isolation with adjunctive linear ablation vs. circumferential pulmonary vein isolation alone for long-standing persistent atrial fibrillation: a randomized pilot study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Trial
- Delayed reconnection of the posterior wall inferior line after biatrial Cox-Maze IV despite previously confirmed bidirectional block.HeartRhythm case reports · 2026Article
- Left Atrial Appendage Aneurysm: A Visible Phenotype of Atrial Disease.JACC. Case reports · 2026Article
- Atrial Fibrillation Burden: Assessment, Clinical Significance, and Therapeutic Implications.Life (Basel, Switzerland) · 2026Review
- Evolution of Energy Sources in Surgical Ablation of Atrial Fibrillation: Current Technology and Future Directions.Reviews in cardiovascular medicine · 2026Review
- Safety and Efficacy of Stand-Alone and Hybrid Thoracoscopic Atrial Fibrillation Ablation.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Impact of Tricuspid Regurgitation on Outcomes After Cox-Maze IV Procedure.The Annals of thoracic surgery · 2026Article
- The long-term outcomes of concomitant Cox-Maze IV procedure in patients with mitral valve disease and atrial fibrillation.The Journal of thoracic and cardiovascular surgery · 2025Article
- Brazilian Atrial Fibrillation Guidelines - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Long-Term Outcomes of Concomitant Left-Sided Cryoablation During Totally Endoscopic Mitral Valve Surgery.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Article
- Long-term outcomes of Cox-Maze IV in patients undergoing multiple concomitant cardiac procedures: Is a complex surgery a barrier to rhythm success?Turk gogus kalp damar cerrahisi dergisi · 2025Article
- In-hospital complications of hybrid vs endocardial atrial fibrillation ablation.Heart rhythm O2 · 2025Article
- 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
- Left atrial and ventricular remodeling in chronic mitral regurgitation.The Journal of thoracic and cardiovascular surgery · 2025Article
- Beyond the pulmonary vein isolation-is alcohol substrate modification the best option for persistent atrial fibrillation?Journal of thoracic disease · 2025Article
- A Hybrid Minimally Invasive Atrial Fibrillation Ablation Procedure Using Unilateral Thoracoscopy and Endocardial Pulsed Field Ablation: An Early Feasibility Study.Journal of cardiovascular development and disease · 2025Article
- Catheter Ablation of Atrial Fibrillation: Technique and Future Perspectives.Journal of clinical medicine · 2025Review
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveSurgical ablation of atrial fibrillation (AF) is indicated both in patients with AF undergoing concomitant cardiac surgery and in those who have not responded to medical and/or catheter-based ablation therapy. This study examined our long-term outcomes following the Cox-Maze IV procedure (CMP-IV).
methodsBetween May 2003 and March 2018, 853 patients underwent either biatrial CMP-IV (n = 765) or a left-sided CMP-IV (n = 88) lesion set with complete isolation of the posterior left atrium. Freedom from atrial tachyarrhythmia (ATA) was assessed for up to 10 years. Rhythm outcomes were compared in multiple subgroups. Predictors of recurrence were determined using Fine-Gray regression, allowing for death as the competing risk.
resultsThe majority of patients (513/853, 60%) had nonparoxysmal AF. Twenty-four percent of patients (201/853) had not responded to at least 1 catheter-based ablation. Prolonged monitoring was used in 76% (647/853) of patients during their follow-up. Freedom from ATA was 92% (552/598), 84% (213/253), and 77% (67/87) at 1, 5, and 10 years, respectively. By competing risk analysis, incidence of first ATA recurrence was 11%, 23%, and 35% at 1, 5, and 10 years, respectively. On Fine-Gray regression, age, peripheral vascular disease, nonparoxysmal AF, left atrial size, early postoperative ATAs, and absence of sinus rhythm at discharge were the predictors of first ATA recurrence over 10 years of follow-up.
conclusionsThe CMP-IV had an excellent long-term efficacy at maintaining sinus rhythm. At late follow-up, the results of the CMP-IV remained superior to those reported for catheter ablation and other forms of surgical ablation for AF. Age, left atrial size, and nonparoxysmal AF were the most relevant predictors of late recurrence.
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