GLOSSARY OF ABBREVIATIONS:AAD (antiarrhythmic drug), AF (atrial fibrillation), ATA (atrial tachyarrhythmia), BMI (body mass index), CABG (coronary artery bypass graft), CHA2DS2-VASc (congestive heart failure hypertension age ≥75 (doubled) diabetes mellitus prior stroke, transient ischemic attack or thromboembolism (doubled) vascular disease age 65 to 74 sex category (female)), CHB (complete heart block), CHF (congestive heart failure), CI (confidence interval), CL (confidence limits), CMP (Cox-Maze procedure), CMP-IV (Cox-Maze IV procedure), CPB (cardiopulmonary bypass), GEE (generalized estimating equation), GLA (giant left atrium), HF (heart failure), ICU (intensive care unit), ILR (implantable loop recording), IQR (interquartile range), LVEF (left ventricular ejection fraction), MV (mitral valve), MVR (mitral valve repair or replacement), NYHA (New York Heart Association), OAC (oral anticoagulant), POC (People of Color), RR (risk ratio), SA (surgical ablation), SD (standard deviation), SR (sinus rhythm), SSS (sick sinus syndrome), STS (Society of Thoracic Surgeons), TEE (transesophageal echocardiography)
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Conflict of Interest Disclosure
R.J.D. – Atricure, Inc: Speaker and receives research funding; Medtronic: Consultant.
Other authors have nothing to disclose.
Funding Sources: This work was supported by the National Institutes of Health RO1-HL032257 to R.J.D.; T32-HL007776 to R.J.D., M.M.O.M., and M.O.K.; and the Barnes-Jewish Foundation.
IRB number and most recent approval date: 201105322, 02/14/22
CENTRAL PICTURE: Freedom from ATAs after CMP-IV in GLA and non-GLA patients.
CENTRAL MESSAGE: Left atrial diameter greater than 6.5cm should not preclude a patient with atrial fibrillation from undergoing a biatrial Cox-Maze IV procedure with full left posterior atrial box lesion set.
PERSPECTIVE STATEMENT: Giant left atrium (GLA; LA diameter >6.5cm) is commonly used as a relative contraindication to performing surgical ablation in patients with atrial fibrillation. This study showed good long-term efficacy of the Cox-Maze IV procedure in GLA patients as compared to non-GLA patients. Over 80% of GLA patients were atrial-tachyarrhythmia-free at 5 years postoperatively.