The Cox-Maze III procedure success rate: comparison by electrocardiogram, 24-hour holter monitoring and long-term monitoring

Ann Thorac Surg. 2009 Jul;88(1):101-5. doi: 10.1016/j.athoracsur.2009.04.014.


Background: The detection of atrial arrhythmia recurrence is more accurate when using long-term (5 days to 3 weeks) continuous monitoring devices. In this study, we focus on the comparison of the recurrence of atrial arrhythmias in patients after the Cox-Maze III procedure obtained by three modalities: electrocardiography (ECG), 24-hour Holter monitoring, and long-term monitoring (LTM).

Methods: Patients with follow-up longer than 6 months who reported sinus rhythm while not taking antiarrhythmic drugs were eligible. Atrial arrhythmias longer than 30 s were considered a recurrence. The ECG, 24-hour Holter monitoring, and LTM (5 days) reports were ascertained and compared at the same time.

Results: Patients (n = 291) underwent the full Cox-Maze III procedure, with 194 eligible for the study and 76 agreeing to participate. The average time to monitoring after surgery was 9.8 (+/- 7.7) months. The ECGs determined 96% of patients in sinus rhythm, Holter monitoring determined 91% in sinus rhythm, and LTM indicated 84% in sinus rhythm. Comparing ECG results and LTM results revealed that 9 patients (12%) had a significant rhythm change. Holter monitoring did not capture all the patients having events lasting longer than 1 hour. No additional information was captured by the use of LTM in patients with paroxysmal atrial fibrillation.

Conclusions: This study reconfirmed that ECG overestimated the success rate after the Cox-Maze III operation by 12% compared with LTM. These changes may carry clinical significance when determining the success of the Cox-Maze III procedure and determining the medical management, including antiarrhythmic and anticoagulation therapy, of the patients who were found to have significant events.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / methods*
  • Cohort Studies
  • Electrocardiography / methods*
  • Electrocardiography, Ambulatory / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / instrumentation*
  • Monitoring, Physiologic / methods
  • Postoperative Care / methods
  • Probability
  • Recurrence
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome