Introduction:
Much of work published on Cox-Maze procedure results has utilized EKGs or 24-hour Holter without information on anti-arrhythmic drugs (AAD). The purpose of this study was to explore results at 6 and 24 months following the Cox-Maze procedure using various rhythm monitoring techniques.
Hypothesis:
It was hypothesized that long-term monitoring (LTM) would identify more patients who experienced atrial arrhythmia (AA) at each time point than other monitoring techniques.
Methods:
Cox-Maze III/IV patients off AAD were offered 1-week LTM with n=220 at 6 and n=94 at 24 months. EKG, 24-hour Holter, and LTM were ascertained at the same time. The HRS definition (AA >30 seconds) was used for ablation failure.
Results:
At 6 months EKG found n=216 returned to sinus rhythm (SR), 24-hr Holter found n=211 returned to SR, while n=203 were in SR by LTM (FIGURE). Of patients experiencing AA at 6 months, duration <1 hour was documented in 56% by 24-hr Holter and 59% by LTM (FIGURE). At 24 months, EKG found n=89 returned to SR, 24-hr Holter found n=88 returned to SR, while n=85 were in SR by LTM. Of patients experiencing AA at 24 months, duration <1 hour was documented in 50% by 24-hr Holter and 67% by LTM. At 6 months, percent in SR differed for EKG vs LTM (p<0.001) and 24-hr Holter vs LTM (p=0.02). At 24 months, monitoring methods did not differ.
Conclusions:
The Cox-Maze procedure demonstrated high return to SR off AAD, regardless of monitoring technique. However, LTM provides more accuracy earlier in postoperative period and should be used when discussing discontinuation of anticoagulation. Due to clinical and financial challenges in applying LTM, patients in which LTM has most value should be identified.