Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting

Matthew R. Schill, Farah N. Musharbash, Vivek Hansalia, Jason W. Greenberg, Spencer J. Melby, Hersh S. Maniar, Laurie A. Sinn, Richard B. Schuessler, Marc R. Moon, Ralph J. Damiano

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objective Most patients with atrial fibrillation (AF) undergoing cardiac surgery do not receive concomitant ablation. This study reviewed outcomes of patients with AF undergoing Cox-maze IV (CMIV) procedure with radiofrequency and cryoablation and coronary artery bypass grafting (CABG) at our institution. Methods Between the introduction of radiofrequency ablation in 2002 and 2015, 135 patients underwent left- or biatrial CMIV with CABG. Patients undergoing other cardiac procedures, except mitral valve repair, or who had emergent, reoperative, or off-pump procedures were excluded. Eighty-three patients remained in the study group after exclusion criteria were applied. Freedom from atrial tachyarrhythmias (ATAs) was ascertained using electrocardiogram, Holter monitor, or pacemaker interrogation at 1 to 5 years postoperatively. Results Operative mortality was 3%. Freedom from ATAs at 1 year in the CMIV group was 98%, with 88% off antiarrhythmia drugs. Freedom from ATAs and antiarrhythmia drugs was 70% at 5 years. Conclusions The addition of CMIV to CABG resulted in excellent freedom from ATAs at 1 to 5 years. These patients are at increased risk for nonfatal complications compared with others undergoing concomitant surgical ablation.

Original languageEnglish
Pages (from-to)1087-1094
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number5
StatePublished - May 2017


  • ablation
  • arrhythmia therapy
  • atrial fibrillation
  • coronary artery bypass grafting


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