Single‐Center Success of Concomitant Cryothermal Cox‐Maze IV Procedure

Background . Despite the guideline recommendation, implementation of the Cox‐maze (CM) IV procedure has been variable and current data are limited. Methods . We reviewed patients with concomitant CM IV procedure (05/2019−05/2020). The primary endpoints of the study were the success rate of surgical ablation and continuity of sinus rhythm (SR) 1 year after surgery. Secondary endpoints included permanent pacemaker (PPM) implantation, postoperative mortality, and identification of predictors for postoperative SR. Results . The concomitant CM IV procedure was performed in 92 patients. Indications were persistent atrial fibrillation (AF) in 40 patients (43.5%), paroxysmal AF in 36 (39.1%), and long‐standing persistent AF in 16 (17.4%). At hospital discharge, SR was achieved in 49 patients (63.6%) and PPM implantation was necessary in 12 patients (13%). At 1 year after surgical ablation, SR was seen in 31 patients (59.6%) and PPM implantation was required in six further patients (6.5%). Patients with long‐standing persistent AF were significantly less likely to achieve SR (odds ratio (OR): 0.18, p = 0.003), and postoperative mortality was significantly increased in this subgroup (hazard ratio (HR): 5.4, p = 0.02). In patients with enlarged left atrial (LA) diameter, the probability of achieving SR was significantly decreased (OR: 0.48, p = 0.045). Need for postoperative dialysis (HR: 12.9, p = 0.02) and prolonged stay in the intensive care unit (HR: 2.2, p = 0.01) were independently associated with increased mortality after CM IV. Conclusions . The cryothermal CM IV procedure has an overall 1‐year success rate of 60% with increased rates of PPM implantation. Patients with long‐standing persistent AF and increased LA diameter were significantly less likely to achieve SR.