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Long-term Outcomes of the Cox Maze III Procedure versus Radiofrequency Catheter Ablation for the Treatment of Atrial Fibrillation

1 January 2011


Background: Atrial fibrillation is a challenging medical condition affecting over 2 million Americans today. The cure for atrial fibrillation has been controversial; however, radiofrequency catheter ablation and the Cox maze III procedure have been forerunners as curative therapies for decades. At this time, there is no medical evidence promoting one therapy over the other using reoccurrence of atrial fibrillation and the need for additional pharmaceutical therapy as endpoints. Both undesirable outcomes should be the primary measure of long-term efficacy of treatment to determine the gold standard. A systematic review was performed on current clinical evidence and the quality of evidence was evaluated with the GRADE working group tool.

Method: An exhaustive search of available medical literature was conducted using EBM Reviews Multifile, Medline and CINAHL databases. Keywords used were atrial fibrillation, radiofrequency catheter ablation, maze and long term. Studies not evaluating atrial fibrillation solely and studies not evaluating radiofrequency catheter ablation and the Cox maze III procedure as primary procedures were excluded from the review.

Results: Four observational case series met the inclusion and exclusion criteria. Long-term follow-up showed the necessity of repeat ablation procedures for approximately a 50% cure rate in comparison to over a 90% cure rate in patients who underwent the Cox maze III procedure once.

Conclusion: The Cox maze III, although having a slightly higher risk for mortality, has shown a significantly higher and long-term cure rate. Using the GRADE tool, the studies examined yielded low quality evidence indicating further investigation is warranted with higher quality studies and larger study samples.


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