A Simpler Way to Cure Atrial Fibrillation

Cardiac surgeons at Washington University School of Medicine (St. Louis, MO, USA) have reported further results of the Cox-maze IV clinical study, a simplified cardiac ablation procedure the surgeons believe can replace the older cut and sew Cox-maze III, in which 10 precisely placed incisions in the heart muscle created a maze to redirect errant electrical impulses.

Cox-maze IV is performed with a clamp-like instrument that ablates heart tissue by using radiofrequency energy. By holding areas of the heart within the jaws of the device, surgeons can create lines of ablation, or scar tissue, on the heart muscle. The ablation lines redirect the abnormal electrical currents responsible for atrial fibrillation. In the older Cox-maze III procedure, the lines of ablation were made by cutting the heart muscle, sewing the incisions back together, and letting a scar form. The researchers found that Cox-maze IV was just as effective as Cox-maze III, yet takes one-third the time to perform. The findings were reported in the February 2007 issue of the Journal of Thoracic and Cardiovascular Surgery.

"This is the first documentation of the effectiveness of the ablation devices compared to the incisions of the Cox-maze III,” said Prof. Ralph Damiano Jr., M.D., chief of cardiac surgery at the School of Medicine, and a cardiac surgeon at Barnes-Jewish Hospital (St. Louis, MO, USA). "Instead of reserving the Cox-maze procedure for a select group of patients, we would urge use of this device for virtually all patients who have atrial fibrillation and are scheduled for other cardiac surgery.”

AF can cause fatigue, shortness of breath, exercise intolerance, and palpitations. Patients with the disorder are five times more likely to suffer from stroke and have up to a two-fold higher risk of death. For some patients, medications can control the abnormal heart rhythms and the risk of clotting associated with AF, but unlike the Cox-maze procedure, the drugs do not cure the disorder.


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