PMID- 26209496
OWN - NLM
STAT- MEDLINE
DCOM- 20160106
LR  - 20220318
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 100
IP  - 4
DP  - 2015 Oct
TI  - Effectiveness of Surgical Ablation in Patients With Atrial Fibrillation and 
      Aortic Valve Disease.
PG  - 1253-9; discussion 1259-60
LID - S0003-4975(15)00618-9 [pii]
LID - 10.1016/j.athoracsur.2015.04.016 [doi]
AB  - BACKGROUND: In patients with atrial fibrillation (AF), the addition of surgical 
      ablation to aortic valve replacement (AVR) does not increase procedural morbidity 
      or mortality. However, efficacy in this population has not been carefully 
      evaluated. This study compared outcomes between patients undergoing stand-alone 
      Cox-Maze IV with those undergoing surgical ablation and concomitant AVR. METHODS: 
      From January 2002 to May 2014, 188 patients received a stand-alone Cox-Maze IV (n 
      = 113) or surgical ablation with concomitant AVR (n = 75). In the concomitant AVR 
      group, patients underwent Cox-Maze IV (n = 58), left-sided Cox-Maze IV (n = 3), 
      or pulmonary vein isolation (n = 14). Thirty-one perioperative variables were 
      compared. Freedoms from AF on and off antiarrhythmic drugs were evaluated at 3, 
      6, 12, and 24 months. RESULTS: Follow-up was available in 97% of patients. 
      Freedom from AF on and off antiarrhythmic drugs in patients receiving a 
      stand-alone Cox-Maze IV versus concomitant AVR was not significantly different at 
      any time point. The concomitant AVR group had more comorbidities, paroxysmal AF, 
      pacemaker implantations (24% vs 5%, p = 0.002), and complications (25% vs 5%, p < 
      0.001). Freedoms from AF off antiarrhythmic drugs for patients receiving an AVR 
      and pulmonary vein isolation at 1 year was only 50%, which was significantly 
      lower than patients receiving an AVR and Cox-Maze IV ( 94%, p = 0.001). 
      CONCLUSIONS: A Cox-Maze IV with concomitant AVR is as effective as a stand-alone 
      Cox-Maze IV in treating AF, even in an older population with more comorbidities. 
      Pulmonary vein isolation was not as effective and is not recommended in this 
      population. A Cox-Maze IV should be considered in all patients undergoing AVR 
      with a history of AF.
CI  - Copyright (c) 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Henn, Matthew C
AU  - Henn MC
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Lawrance, Christopher P
AU  - Lawrance CP
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Sinn, Laurie A
AU  - Sinn LA
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Miller, Jacob R
AU  - Miller JR
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Schuessler, Richard B
AU  - Schuessler RB
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Moon, Marc R
AU  - Moon MR
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Melby, Spencer J
AU  - Melby SJ
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Maniar, Hersh S
AU  - Maniar HS
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
FAU - Damiano, Ralph J Jr
AU  - Damiano RJ Jr
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri. Electronic 
      address: damianor@wustl.edu.
LA  - eng
GR  - R01 HL032257/HL/NHLBI NIH HHS/United States
GR  - T32 HL007776/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20150722
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve
MH  - Atrial Fibrillation/epidemiology/*surgery
MH  - Cardiac Surgical Procedures/*methods
MH  - *Catheter Ablation
MH  - Comorbidity
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC4593713
MID - NIHMS679745
EDAT- 2015/07/26 06:00
MHDA- 2016/01/07 06:00
PMCR- 2016/10/01
CRDT- 2015/07/26 06:00
PHST- 2015/01/26 00:00 [received]
PHST- 2015/03/27 00:00 [revised]
PHST- 2015/04/01 00:00 [accepted]
PHST- 2015/07/26 06:00 [entrez]
PHST- 2015/07/26 06:00 [pubmed]
PHST- 2016/01/07 06:00 [medline]
PHST- 2016/10/01 00:00 [pmc-release]
AID - S0003-4975(15)00618-9 [pii]
AID - 10.1016/j.athoracsur.2015.04.016 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2015 Oct;100(4):1253-9; discussion 1259-60. doi: 
      10.1016/j.athoracsur.2015.04.016. Epub 2015 Jul 22.