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Surgical ablation of atrial fibrillation: The Maze IV procedure is significantly superior to other ablation procedures
Huiming Guo, Cong Lu, Huanlei Huang, Bin Xie, Xiaosheng Zhang, Jian Liu, Wenda Gu, Jimei Chen, Jian Zhuang.
Guangdong General Hospital, Guangzhou, China.

OBJECTIVE: The Maze III procedure is the most effective surgical technique to treat atrial fibrillation(AF) , and it is also the gold-standard to judge the clinical effects of so called “modified Maze procedure”. Since several new ablation tools were developed, the ablation lesions have been changed, which lead to the fall of success rate. Maze IV procedure is closer to Maze III procedure than any other modified Maze procedure. We performed Maze IV procedure using monopolar together with bipolar ablation tools simultaneously. This study examined the preoperative and perioperative variables to assess the clinical effect and safety of Maze IV procedure.
METHODS: During December 2014 to April 2015, 23 valvular long-standing atrial fibrillation patients and 3 isolating atrial fibrillation patients (paroxysmal Af, 1 ; long-standing Af, 2) underwent Maze IV procedure. All these cases were compared with cases in existed database to determine the heart rhythm on 24h holter at discharge, 3 months and 6 months post operation.
RESULTS: No hospital mortality was observed. The ablation time of Maze IV group was significantly longer than the control group (15.7 vs. 10min, p<0.01). One patient in Maze IV group had Af recurrence before discharge, the heart rhythm returned to SR after electrical cardioversion and stay SR at 3 months’ follow-up. SSS revealed in one case, permanent pace-maker was implanted. All the patients were followed-up. During the follow-up, no stroke and death was observed. The SR rate at discharge was 96.2% vs. 46.2% (p=0.04). The SR rate at follow-up of 3 months or 6months was 95.5% vs. 88.5% and 95.5% vs 61.3% (p=0.03), respectively. The atrial flutter rate was 0 vs. 11.5%( p=0.07).
CONCLUSIONS: The Maze IV procedure has higher success rate and lower atrial flutter rate while longer ablation time and increase of cost.

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