Atrial Fibrillation: Treatment Cox Maze III Procedure

Surgical procedures for the treatment of atrial fibrillation have resulted in dramatic successes. The Cox-Maze III procedure was specifically designed to eliminate a fib, restore A-V synchrony and transport, reduce the need for antiarrhythmic medications, and eliminate LV dysfunction related to a fib.  It has proved to be extraordinarily effective in curing that arrhythmia and thereby accomplishing the goals for which it was designed.

Other procedures have been designed to treat atrial fibrillation. These include a limited Maze (left or right sides) and catheter based interventions. The success of the procedure employed depends upon the underlying nature of the arrhythmia. Atrial fibrillation is classified into two distinct groups. Intermittent atrial fibrillation is induced by triggers in the pulmonary veins (90%) and each individual episode of a fib is dependent of triggers in the veins for induction. Most of these patients can be cured by isolation of the pulmonary veins using a limited surgical approach. Continuous a fib is dependent on macro-reentrant circuits in the atria and is self perpetuation. It cannot be cured by pulmonary vein isolation but instead requires the creation of a single pathway through the atrium to redirect the macro re-entrant arrhythmia.

We have performed the Cox-Maze III procedure over the past six years at NMH. It has resulted in a restoration of A-V synchrony in 95% of patients,  20% have required pacemaker implantation because of preoperative sick sinus syndrome, and 80% are on reduced drug regimens. The stroke rate has been 0%.

The morbidity of a fib can be considerable over time. Certainly it can have life long implications if patients are disabled by stroke. We have been very gratified by the results of the Cox-Maze III as a definitive therapy for this patient group. Our patients have been very pleased with the return to sinus rhythm.