Long-term results of radiofrequency maze procedure for persistent atrial fibrillation with concomitant mitral surgery

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia and present in 0.4% of the general population (1). The risk of systemic embolization, cardiac morbidities and mortality are increased in the patients with AF (2,3). In patients undergoing off-pump coronary artery bypass grafting, postoperative AF could even cause delayed stroke (4). Anticoagulation therapy has been recommended for prevention of systemic embolization. However, the attitude for anticoagulation therapy for the patients with AF at peri-stroke period is rather conservative due to the concern regarding the late hemorrhagic complication (5). In the patients underwent mitral surgery, concomitant AF is present in as high as 50% of patients (6). Cox et al. developed Cox Maze procedure and successfully treated the patients with drug-refractory AF (7,8). Since the original maze procedure required extensive cut-and-saw in both atria, modified maze procedure using variable energy sources to achieve the ablative purpose were developed (9-14). However, the long-term results and predictors for late AF recurrence are still under investigation. This study investigated the long-term results and the predictive values for late AF recurrence in 207 consecutive patients after mitral surgery and radiofrequency (RF) maze procedure for persistent AF