초록접수 현황
| 14F-193 | 구연 발표 |
Mid-term Efficacy of the Asan Medical Center Modification of the Original Cox-Maze III Procedure
이성준, 유재석, 김준범, 정성호, 주석중, 정철현, 이재원
울산대학교 의과대학 서울아산병원 흉부외과학교실
Background : Our modification of the original Cox-Maze III procedure (AMC technique) has a major difference in the right side lesion set, which includes an oblique right atrial (RA) incision to facilitate an RA reduction, elimination of the 10 o’clock ablation to preserve sinus nodal function, and cavotricuspid isthmus ablation to reduce atrial flutter (Figure A). This study aimed to compare the clinical outcomes of AMC technique vs. Cox-Maze III procedure.¹
Methods : From January 2013 to January 2014, 198 patients underwent surgical AF ablation using either AMC technique (AMC group, N=120) or Cox-Maze III procedure (Cox-Maze group, n=78). Rhythm outcomes were assessed by regular ECGs and Holter monitoring. AF recurrence was regarded as any AF or atrial flutter episodes after 3 months of postoperative blanking period. To adjust the intergroup baseline differences, inverse-probability-of-treatment weighting (IPTW) method was used.
Results : There were no differences in the immediate postoperative complication rates including permanent pacemaker insertion (3.3% vs 1.3%, P=0.37). Although the rates of AF at pre-discharge were not different between the 2 groups (5.8% vs 2.6%, P=0.29), the rates of sinus rhythm were significantly different (89.2% vs 62.8%, P<0.001). The rates of junctional rhythm at pre-discharge were 4.2% vs. 34.6% (P<0.001).
At a median of 17.5 months (interquartile range; 8.9-26.7 months), freedom from AF were 86.4% in the Cox-Maze group and 80.7% in the AMC technique (P=0.16; Figure B). After adjustment using the weighted Cox-regression models, there were no significant differences between the 2 groups (hazard ratio, 1.40; 95% confidence interval, 0.49-4.02; P=0.54; Figure C).
Conclusion : Mid-term efficacy of AF ablation appears to be comparable with original Cox-Maze III procedure, but AMC technique is expected to be favorable for immediate postoperative sinus rhythm conversion and recovery of nodal function.
Methods : From January 2013 to January 2014, 198 patients underwent surgical AF ablation using either AMC technique (AMC group, N=120) or Cox-Maze III procedure (Cox-Maze group, n=78). Rhythm outcomes were assessed by regular ECGs and Holter monitoring. AF recurrence was regarded as any AF or atrial flutter episodes after 3 months of postoperative blanking period. To adjust the intergroup baseline differences, inverse-probability-of-treatment weighting (IPTW) method was used.
Results : There were no differences in the immediate postoperative complication rates including permanent pacemaker insertion (3.3% vs 1.3%, P=0.37). Although the rates of AF at pre-discharge were not different between the 2 groups (5.8% vs 2.6%, P=0.29), the rates of sinus rhythm were significantly different (89.2% vs 62.8%, P<0.001). The rates of junctional rhythm at pre-discharge were 4.2% vs. 34.6% (P<0.001).
At a median of 17.5 months (interquartile range; 8.9-26.7 months), freedom from AF were 86.4% in the Cox-Maze group and 80.7% in the AMC technique (P=0.16; Figure B). After adjustment using the weighted Cox-regression models, there were no significant differences between the 2 groups (hazard ratio, 1.40; 95% confidence interval, 0.49-4.02; P=0.54; Figure C).
Conclusion : Mid-term efficacy of AF ablation appears to be comparable with original Cox-Maze III procedure, but AMC technique is expected to be favorable for immediate postoperative sinus rhythm conversion and recovery of nodal function.
책임저자: 이재원
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 이성준, Tel: 02-3010-3580 , E-mail : medics97@naver.com
