Modification of the Cox-Maze III Procedure Using Bipolar Radiofrequency Ablation

The Cox-Maze III procedure remains the yardstick by which all treatments for atrial fibrillation are measured. This procedure is not widely adopted because of its perceived technical complexity, invasiveness and longer procedural time. Efforts have been made by various investigators to reproduce Dr Cox's results using alternative lesion sets and energy sources. Bipolar radiofrequency (BPRF) ablation avoids the morbidity of cut-and-sew lesions, reduces procedural time and increases the likelihood of transmurality and continuity of lesions created compared to unipolar devices. Initial results are encouraging. We present our surgical technique and early experience using BPRF modification of the Cox-Maze III procedure using the Medtronic Cardioblate® BP system.