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The Cox-Maze IV procedure for lone atrial fibrillation.

Numerous devices are being used for the ablation of atrial fibrillation. All of the technologies used appropriately can be effective in the clinical situation. At our institution, we have favored bipolar radiofrequency ablation. Numerous experimental studies in our laboratory have shown that these devices provide reliable lesion transmurality and safety. We also have utilized cryosurgery at the valve annuli. These technologies have been used to replace most of the incisions of the Cox-Maze procedure. This new operation has been termed the Cox-Maze IV, and can be performed either through a median sternotomy or through a right mini-thoracotomy. This modified operation requires only two small atriotomies. The right heart ablations can be performed on the beating heart, but left atrial lesions are created on the arrested heart. The left atrial appendage is always amputated or excluded. In our hands, this procedure has been able to cure over 90% of patients, both with paroxysmal and permanent atrial fibrillation.