{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:22:38Z","timestamp":1787008958636,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Heart and Lung Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>This study evaluated the long-term risk of permanent pacemaker implantation following Cox-maze IV (CMIV) and concurrent mitral valve surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective, nationwide, registry-based analysis was conducted on postoperative permanent pacemaker implantation in 397 patients with symptomatic mitral valve insufficiency and atrial fibrillation who underwent CMIV and mitral valve surgery in Sweden between 2009 and 2017. They were compared to a registry group of 346 patients with atrial fibrillation who underwent mitral valve surgery without surgical ablation during 2014\u20132017. The follow-up ended on 30 September 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>CMIV patients were on average 4 years younger and had lower surgical risk than registry patients. More CMIV patients underwent early (&amp;lt;30\u2009days) pacemaker implantation (13.3% vs. 5.5%, P\u2009=\u20090.002). CMIV patients had a doubled adjusted risk of requiring a pacemaker compared to registry patients after 8\u2009years [HR 1.96, 95% CI 1.27\u20133.04]. In the CMIV group, 22% (95% CI 18\u201326%) had a pacemaker by 5\u2009years, increasing to 27% (95% CI 22\u201331%) by 8\u2009years, compared to 13% (95% CI 10\u201317%) at both time intervals in the registry group. Atrioventricular block II\/III accounted for &amp;gt;60% of early pacemaker indications in both groups, and sinus node dysfunction was the indication for late pacemaker implantation in 48% in the CMIV group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients undergoing CMIV concomitant with mitral valve surgery have a higher rate of postoperative pacemaker implantation compared to patients with atrial fibrillation undergoing mitral valve surgery alone. Sinus node dysfunction was the main indication for late pacemaker among CMIV patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf085","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T08:10:27Z","timestamp":1743667827000},"source":"Crossref","is-referenced-by-count":1,"title":["High incidence of permanent pacemaker after Cox-maze IV and mitral valve surgery: a nationwide registry-based study"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4052-7574","authenticated-orcid":false,"given":"Torbj\u00f6rn","family":"Ivert","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Karolinska University Hospital and Molecular Medicine and Surgery, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-0890","authenticated-orcid":false,"given":"Gabriella","family":"Boano","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Unit of Cardiovascular Medicine, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]},{"name":"Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-091X","authenticated-orcid":false,"given":"Farkas","family":"Vanky","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Unit of Cardiovascular Medicine, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]},{"name":"Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Gadler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institutet, Solna , Stockholm,","place":["Sweden"]},{"name":"Department of Cardiology, Karolinska University Hospital, Solna , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-0452","authenticated-orcid":false,"given":"Anders","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Heart Centre, University Hospital , Ume\u00e5,","place":["Sweden"]},{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University , Ume\u00e5,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3393-5366","authenticated-orcid":false,"given":"Lena","family":"Jid\u00e9us","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery and Anesthesiology, University Hospital , Uppsala,","place":["Sweden"]},{"name":"Department of Surgical Sciences, University Hospital , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3844-6128","authenticated-orcid":false,"given":"Birgitta","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital\/\u00d6stra , Gothenburg,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Kenneb\u00e4ck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Karolinska University Hospital, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-864X","authenticated-orcid":false,"given":"Shahab","family":"Nozohoor","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Lund University, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]},{"name":"Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Scherst\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Sahlgrenska University Hospital , Gothenburg,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7965-7491","authenticated-orcid":false,"given":"Johan","family":"Sj\u00f6gren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Lund University, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]},{"name":"Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-8996","authenticated-orcid":false,"given":"Anders","family":"Wickbom","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, \u00d6rebro University Hospital , \u00d6rebro,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2708-1376","authenticated-orcid":false,"given":"\u00d6rjan","family":"Friberg","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, \u00d6rebro University Hospital , \u00d6rebro,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-0912","authenticated-orcid":false,"given":"Anders","family":"Alb\u00e5ge","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery and Anesthesiology, University Hospital , Uppsala,","place":["Sweden"]},{"name":"Department of Surgical Sciences, University Hospital , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"2025042217471618800_ivaf085-B1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jacc.2018.10.067","article-title":"Long-term implications of atrial fibrillation in patients with degenerative mitral regurgitation","volume":"73","author":"Grigioni","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025042217471618800_ivaf085-B2","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/01.CIR.98.10.946","article-title":"Impact of atrial fibrillation on the risk of death: the Framingham Heart Study","volume":"98","author":"Benjamin","year":"1998","journal-title":"Circulation"},{"key":"2025042217471618800_ivaf085-B3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0002-9343(02)01236-6","article-title":"A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew\/Paisley study","volume":"113","author":"Stewart","year":"2002","journal-title":"Am J Med"},{"key":"2025042217471618800_ivaf085-B4","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/0003-4975(93)90338-I","article-title":"Five-year experience with the maze procedure for atrial fibrillation","volume":"56","author":"Cox","year":"1993","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B5","doi-asserted-by":"crossref","first-page":"212","DOI":"10.3109\/14017431.2012.671489","article-title":"A Swedish consensus on the surgical treatment of concomitant atrial fibrillation","volume":"46","author":"Ahlsson","year":"2012","journal-title":"Scand Cardiovasc J"},{"key":"2025042217471618800_ivaf085-B6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jtcvs.2006.10.009","article-title":"The effect of ablation technology on surgical outcomes after the Cox-maze procedure: a propensity analysis","volume":"133","author":"Lall","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B7","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1016\/S0022-5223(03)01287-X","article-title":"The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures","volume":"126","author":"Prasad","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B8","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1080\/140174300750064648","article-title":"The Maze operation for treatment of atrial fibrillation. Early clinical experience in a Scandinavian institution","volume":"34","author":"Albage","year":"2000","journal-title":"Scand Cardiovasc J"},{"key":"2025042217471618800_ivaf085-B9","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/pace.12286","article-title":"Low mortality and low rate of perceived and documented arrhythmias after Cox maze III surgery for atrial fibrillation","volume":"37","author":"Johansson","year":"2014","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025042217471618800_ivaf085-B10","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/S0022-5223(95)70244-X","article-title":"Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results","volume":"110","author":"Cox","year":"1995","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B11","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1016\/j.athoracsur.2011.07.058","article-title":"Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation","volume":"92","author":"Worku","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B12","doi-asserted-by":"crossref","first-page":"3006","DOI":"10.1111\/jocs.16777","article-title":"Mid-term outcomes of concomitant Cox-maze IV: results from a multicenter prospective registry","volume":"37","author":"Gerdisch","year":"2022","journal-title":"J Card Surg"},{"key":"2025042217471618800_ivaf085-B13","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.athoracsur.2006.02.030","article-title":"Surgery for permanent atrial fibrillation: impact of patient factors and lesion set","volume":"82","author":"Gillinov","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B14","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s00595-017-1614-7","article-title":"Predictors of the need for pacemaker implantation after the Cox maze IV procedure for atrial fibrillation","volume":"48","author":"Masaki","year":"2018","journal-title":"Surg Today"},{"key":"2025042217471618800_ivaf085-B15","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/j.athoracsur.2013.03.064","article-title":"Predictors and risk of pacemaker implantation after the Cox-maze IV procedure","volume":"95","author":"Robertson","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B16","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.athoracsur.2007.10.097","article-title":"Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database","volume":"85","author":"Gammie","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B17","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1016\/j.jacc.2019.02.062","article-title":"Pacemaker implantation after mitral valve surgery with atrial fibrillation ablation","volume":"73","author":"DeRose","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025042217471618800_ivaf085-B18","first-page":"1","article-title":"Perioperative and mid-term outcomes of mitral valve surgery with and without concomitant surgical ablation for atrial fibrillation: a retrospective analysis","volume":"39","author":"Pregaldini","year":"2024","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2025042217471618800_ivaf085-B19","first-page":"1","article-title":"Long-term outcomes of minimally invasive concomitant mitral and tricuspid valve surgery with surgical ablation","volume":"39","author":"Yoon","year":"2024","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2025042217471618800_ivaf085-B20","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/j.jtcvs.2013.03.012","article-title":"Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation","volume":"147","author":"Pecha","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B21","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/S0022-5223(19)36685-1","article-title":"The surgical treatment of atrial fibrillation. IV. Surgical technique","volume":"101","author":"Cox","year":"1991","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B22","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/S0022-5223(19)36722-4","article-title":"The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation","volume":"101","author":"Cox","year":"1991","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B23","doi-asserted-by":"crossref","first-page":"i19","DOI":"10.1093\/ejcts\/ezx326","article-title":"The Cox-maze IV procedure in its second decade: still the gold standard?","volume":"53","author":"Ruaengsri","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025042217471618800_ivaf085-B24","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1093\/ejcts\/ezs468","article-title":"EuroSCORE II and the art and science of risk modelling","volume":"43","author":"Nashef","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025042217471618800_ivaf085-B25","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958","journal-title":"J Am Stat Assoc"},{"key":"2025042217471618800_ivaf085-B26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/icvts\/ivy030","article-title":"Validity of the Swedish Cardiac Surgery Registry","volume":"27","author":"Vikholm","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025042217471618800_ivaf085-B27","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jtcvs.2015.09.063","article-title":"Conduction disorders after tricuspid annuloplasty with mitral valve surgery: implications for earlier tricuspid intervention","volume":"151","author":"Jouan","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B28","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/j.athoracsur.2018.05.013","article-title":"The Maze procedure and postoperative pacemakers","volume":"106","author":"Cox","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2025042217471618800_ivaf085-B29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5090\/kjtcs.2017.50.3.163","article-title":"The absence of atrial contraction as a predictor of permanent pacemaker implantation after maze procedure with cryoablation","volume":"50","author":"Jeon","year":"2017","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"2025042217471618800_ivaf085-B30","doi-asserted-by":"crossref","first-page":"1091312","DOI":"10.3389\/fcvm.2023.1091312","article-title":"Sinus node dysfunction and related permanent pacemaker implantation after major cardiac surgeries, systematic review, and meta-analysis","volume":"10","author":"Hosseini Dolama","year":"2023","journal-title":"Front Cardiovasc Med"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf085\/62871792\/ivaf085.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/4\/ivaf085\/62871792\/ivaf085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/4\/ivaf085\/62871792\/ivaf085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T17:47:28Z","timestamp":1745344048000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf085\/8106495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,29]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,29]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf085","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,29]]},"article-number":"ivaf085"}}