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AtriCure continues to recruit physicians interested in becoming arrhythmia surgeons. Training opportunities are available for the AtriCure procedure using the Isolator™ Transpolar™ Ablation System. 

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Continuing the Evolution of AF Surgical Ablation

In 1987, James Cox, MD made a surgical breakthrough with the Cox-Maze I procedure. The surgery was intended to create a "maze" of small incisions (using a scalpel or scissors) along both the right and left atrium. The incisions would be sewn back together; creating scar tissue that would stop the reentry of the irregular electrical impulses that cause atrial fibrillation. For this reason, the Cox-Maze procedures are also commonly known as “cut-and-sew” procedures.

Since that surgery, the Cox-Maze technique has continued to evolve. In the 1990s, the Cox-Maze III established a standard for surgical treatment of atrial fibrillation. In one study, conducted by the Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, showed that 98% of patients had no recurrence of atrial fibrillation at 10 years after surgery. 1

Although the Cox-Maze III procedure was extremely successful, the incision set can be technically difficult to perform. During open heart surgery, the incision set also adds length to an already time-consuming surgery, increasing certain risks associated with an open heart bypass procedure. This has resulted in the limited use of the procedure in both lone and concomitant open heart procedures. 2 Many of the risks of any open-heart cardiopulmonary bypass surgery exist for the Cox-Maze III procedure.

In writing about the complexity of the Cox-Maze III procedure, Dr. Cox stated, "The maze III procedure is so complex that its adoptability is minimal.  This results in an operation that, despite being safe (operative mortality of <1%) and effective (cure rate of >98%), has had little direct effect on the absolute number of patients cured of atrial fibrillation." 3

As energy source technology advanced, surgeons began to realize that the scars necessary to create the "maze" along the atria and to isolate the pulmonary veins potentially could be accomplished with ablation rather than with a scalpel.

In 2000, surgical ablation techniques began to influence the Cox-Maze procedure.  The ability to ablate significantly reduced the amount of time spent in surgery. Surgeons reported that ablation also reduced certain risks inherent in the "cut-and-sew" procedure without decreasing the original Cox-Maze success rates. 4 Ultimately, surgical ablation also allowed for the potential breakthrough of the closed chest, minimally invasive (Mini-Maze) procedure for patients who do not need to undergo open heart procedures.

 

1 Damiano RJ, Gaynor SL, Bailey M, Prasad S, Cox JL, Boineau JP, Schuessler RP The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the cox maze procedure. J Thorac Cardiovasc Surg 2003;126.

2 Gaynor, SL, et al. A prospective, single-center clinical trial of a modified Cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg 2004;128:535-42.

3 Cox, JL. Atrial fibrillation II: rationale for surgical treatment. J Thorac Cardiovasc Surg 2003;126:1693-1699.

4 Lall, SC., et al. The Impact Of Ablation Technology On Surgical Outcomes Following The Cox Maze Procedure: A Propensity Analysis. Discussant: W. Randolph Chitwood; The American Association for Thoracic Surgeons, 86th Annual Meeting; St Louis, MO, Saturday, April 29, 2006.