Surgical ablation for atrial fibrillation is efficacious in patients with giant left atria

Martha M.O. McGilvray, Nadia H. Bakir, Tari Ann E. Yates, Meghan O. Kelly, Laurie A. Sinn, Christian W. Zemlin, Spencer J. Melby, Ralph J. Damiano

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: The Cox-Maze IV procedure (CMP-IV) is the most effective treatment for atrial fibrillation. Increased left atrial (LA) size has been identified as a risk factor for failure to restore sinus rhythm. This has biased many surgeons against ablation in patients with giant left atrium (GLA), defined as LA diameter >6.5 cm. In this study we aimed to define the efficacy of the CMP-IV in patients with GLA. Methods: From April 2004 through March 2020, 786 patients with a documented LA diameter underwent elective CMP-IV, 72 of whom had GLA. Median follow-up duration was 4 years (interquartile range, 1-7 years). Recurrence was defined as any documented atrial tachyarrhythmia (ATA) lasting 30 seconds. ATA recurrence and survival were analyzed across GLA versus non-GLA groups. Results: Median age at surgery was 65 (interquartile range, 56-73) years. Median LA diameter within the GLA group was 7.0 (range, 6.6-10.0) cm. There were no differences in rates of postoperative complications for the 2 groups, including rate of postoperative stroke and pacemaker placement (GLA 14%; non-GLA 12%; P = .682). A trend toward increased 30-day mortality in the GLA group did not reach statistical significance (GLA 6%; non-GLA 2%; P = .051). Freedom from ATAs at 5 years postoperatively was comparable for the 2 groups (GLA 82%; non-GLA 84%). Conclusions: The CMP-IV had good efficacy in patients with GLA. Our results suggest that LA diameter >6.5 cm should not preclude a patient from undergoing surgical ablation for atrial fibrillation.

Original languageEnglish
Pages (from-to)680-691.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number2
StatePublished - Feb 2024


  • Cox-Maze procedure
  • atrial fibrillation
  • giant left atrium
  • long-term outcomes
  • surgical ablation


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