{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T17:29:36Z","timestamp":1788802176540,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007338","name":"Foundation for Barnes-Jewish Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007338","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox\u2010Maze IV procedure (CMP\u2010IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow\u2010up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Between May 2003 and March 2020, 174 consecutive patients underwent a stand\u2010alone CMP\u2010IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine\u2010Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range: 4.0\u201312.0 years), with 71% (124\/174) having failed at least one prior catheter\u2010based ablation. There were no 30\u2010day mortalities. Freedom from ATAs was 94% (120\/128), 83% (53\/64), and 88% (35\/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the majority of patients having a long\u2010duration of preoperative AF and having failed at least one catheter\u2010based ablation, the stand\u2010alone CMP\u2010IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand\u2010alone CMP\u2010IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15113","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T05:00:50Z","timestamp":1622091650000},"page":"2884-2894","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Efficacy of the stand\u2010alone Cox\u2010Maze IV procedure in patients with longstanding persistent atrial fibrillation"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0964-9474","authenticated-orcid":false,"given":"Martha M.O.","family":"McGilvray","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Barnes\u2010Jewish Hospital Washington University School of Medicine  St. Louis Missouri 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