Biomedicine & Biochemistry

Share this article:

Biomedicine & Biochemistry

  • Join our comunity:

Demystifying the Cox Maze IV Procedure for Surgical Treatment of Atrial Fibrillation

By: , Posted on: October 17, 2017

atrial fibrillation

Atrial Fibrillation, or AF, is the most common cardiac arrhythmia and is endemic in our population, effecting around 5 million Americans.  Think about it… Almost everyone knows or has first-hand experience with someone with this disease.

As a young surgeon I found AF to be beguiling and mysterious—very much like a riddle or a puzzle that only a few surgeons had unlocked.  As I matured it bothered me greatly that while I had mastered many of the other elements of Cardiac Surgery, AF and how to perform an expert Maze remained elusive.  I remained frustrated that only a few leaders knew how to perform the Maze procedure well, and that as one got further and further away from them the confusion swirling about how to perform the operation and what tools to use to create the ablations magnified exponentially.  The only way to solve the mystery was to travel to the source, and thus began a long journey where I befriended both Drs. Cox and Damiano and learned the procedure correctly.  Later when we looked at our performance in national FDA trials our outcomes were fantastic which was the proof of concept for me.  It was then that I knew that if I could learn how to perform this procedure, then so could everyone else.  This was the impulse to write a book that would show others the path to master the Maze.

Part of the challenge was demystifying the confusion around the procedure.  Christian Zemlin and I worked for weeks on the first chapter which may be one of the most important in the book in setting the stage by debunking so many myths and drilling right down to how the maze works, and what can make it fail.  Here we learn that the Maze targets 6 regions in the atrium with 6 ablation lines that are aimed to stop macro-reentrant circuits that may be present at the time of the operation or later.  Each line has to be constructed flawlessly and well anchored to be effective.  Here we introduce pitfalls that most surgeons are unaware of that can sabotage the operation.

Chapter Download: Foundations and Fundamentals

As Cardiothoracic surgeons operate on patients coming to the OR who also have AF—they literally have this once in the patient’s life time chance to perform an operation that has a great chance creating a durable freedom from their AF.  This means getting them off of their medications and potentially their anticoagulation.  It lowers their stroke risk and improves their quality of life.  The positive impact to patients’ lives when a Maze is performed effectively is massive.  Every surgeon performing open heart surgery should be an expert in it.

We hope that our book will serve as a long-awaited guide for learning surgeons at all levels to go to learn how to safely perform a Maze, even in difficult situations.  We also wrote it for fellows, residents, and medical students.  Ironically, we have already learned that patients are also highly interested in the book as want to know more about how the Maze works, how it is performed, and what to look for in surgeons who have mastered it.

There is really no reason to wait to learn how to treat this epidemic.  Make the difference in your patients’ life beginning today.

About the author:

Jonathan PhilpottJonathan Philpott, Director, Electrophysiology Program, Sentara Norfolk General Hospital, Norfolk, VA, USA

Dr. Jonathan Philpott, Medical Director of the Electrophysiology Program at Sentara Norfolk General Hospital, is an internationally renowned expert on the Cox Maze IV procedure, has learned it directly from its inventor Dr. Cox, and since refined his approach in several hundred procedures that he has performed. He is a leading enroller in multiple national clinical trials that have evaluated the Cox Maze IV procedure.

About the book:

Surgical Treatment of Atrial Fibrillation

Surgical Treatment of Atrial Fibrillation: A Comprehensive Guide to Performing the Cox Maze IV Procedure is the first all-inclusive description of this rapidly growing surgery, setting the standard in the field. The Cox-Maze IV procedure is a complex surgery, and its success depends critically on correct execution. With FDA approval, the first RF ablation device for treatment of the Cox-Maze IV procedure has become more important than ever to combine scientific information for the procedure with its connection to human application. This comprehensive work provides step-by-step instructions from an experienced Cox-Maze IV surgeon and is written in the style of a mentor advising his mentee in the operating room. It contains over a dozen lessons described in detail, with illustrations, photographs and a discussion of possible complications and appropriate ways to deal with them.

Need it now? Visit and use discount code STC317 at checkout to save up to 30% on your very own copy!

Connect with us on social media and stay up to date on new articles

Biomedicine & Biochemistry

The disciplines of biomedicine and biochemistry impact the lives of millions of people every day. Research in these areas has led to practical applications in cardiology, cancer treatment, respiratory medicine, drug development, and more. Interdisciplinary fields of study, including neuroscience, chemical engineering, nanotechnology, and psychology come together in this research to yield significant new discoveries. Elsevier’s biomedicine and biochemistry content spans a wide range of subject matter in various forms, including journals, books, eBooks, and online information services, enabling students, researchers, and clinicians to advance these fields. Learn more about our Biomedical and Biochemistry books here.