Immediate and long-term results of the simultaneous rhythm-converting procedure Cox-Maze IV in multivalvular correction

The Cox-Maze IV rhythm-conversion procedure designed to restore sustained sinus rhythm is most effective in patients with paroxysmal and persistent forms of atrial fibrillation, achieving success rates of 61.4% and 58.1%, respectively. This procedure is not associated with a high rate of pacemaker implantation. An enlarged left atrium should not deter the use of the Cox-Maze IV procedure in patients with atrial fibrillation; however, atrioplasty is recommended if the left atrium is significantly enlarged. Episodes of rhythm disturbance during the early postoperative period and a history of atrial fibrillation lasting more than 60 months prior to surgery are associated with an increased risk of recurrence postoperatively. Therefore, careful monitoring of these patients after discharge is essential for early detection and management of recurrences.