Resource of Note—Dr. Jim Cox Comments on Atrial Fibrillation Surgery

July 27, 2008 7:17 AM CT

In a previous Resource of Note, we mentioned various discussion forums, one of which was the A-fibcures group that focuses on non-pharmaceutical cures for atrial fibrillation.

Discussions on the group have recently focused on the struggle to understand the confusing and ever-changing landscape of atrial fibrillation surgery.

To help bring some clarity, group moderator Carl Plaskett reached out to Dr. Jim Cox, the pioneer of treatments for atrial fibrillation. Dr. Cox is known as the “Father of Maze Surgery,” and Maze surgery is known as the Cox-Maze procedure.  

Dr. Cox was kind enough to write up a brief white paper providing history and perspectives on atrial fibrillation surgery. It is now posted at the A-fibcures group.  

White Paper by Dr. Cox  (may require registering)

One of the most fascinating parts of this white paper was the explanation of why treating paroxysmal atrial fibrillation is so different from treating persistent atrial fibrillation, and why the results of atrial fibrillation surgeries vary so widely. Here is what he had to say:

In 1998 (11 years after the first Maze procedure was performed), a French cardiologist named Haissaguerre first demonstrated that most episodes of AF are induced by “triggers” located in and around the part of the left atrium where the pulmonary veins empty into it.

What happened next was earth-shaking to the field of AF therapy. Cardiologists, industry and novice cardiac surgeons all seemed to interpret Haissaguerre’s paper the same way: “AF can be cured by simply isolating the pulmonary veins because that’s where over 90% of the “triggers” for AF episodes are located.”

Well, this was true as far as it went. However, of the 3 million people in the USA with AF, only 60% of them (about 1.8 million) have AF in episodes and the other 40% (about 1.2 million) have AF all of the time, that is they do not have episodes of it. Therefore, the 40% of patients who are in AF all of the time do not depend on the “triggers” for their AF but rather have something else entirely going on in their atria during their continuous AF, something that cannot be cured by simply isolating the pulmonary veins.

Thus, the correct interpretation of Haissaguerre’s paper should have been that theoretically, 90% of 60% of all patients with AF can be cured by isolating the pulmonary veins (that would be 54% overall) and all of the other patients cannot be cured by simple pulmonary vein isolation alone and will need something additional to cure them.

He goes on to talk about how this focus on the pulmonary veins led to a variety of new energy sources and altering of the Maze lesion patterns, and how today, when procedures fail, we can’t tell whether it is the energy source that failed or the lesion pattern.

He also talked about how Maze has evolved into a generic term for any atrial fibrillation surgery, and discusses the cardiologists and their catheter ablations as well.

It’s a fascinating look at where we are, and where we have been, in trying to cure atrial fibrillation.

White Paper by Dr. Cox  (may require registering)