Cox maze procedure

Cox maze procedure
ICD-9-CM 37.33

The Cox maze procedure, also known as maze procedure, is a type of heart surgery for atrial fibrillation.

"Maze" refers to the series of incisions arranged in a maze-like pattern in the atria. Today, various methods of minimally invasive maze procedures, collectively named minimaze procedures, are used.


James Cox, MD, University of TN Medical Center Cardiologist and associates developed the "maze" or "Cox maze" procedure, an "open-heart" cardiac surgery procedure intended to eliminate atrial fibrillation (AF), and performed the first one at St. Louis' Barnes Hospital—now Barnes-Jewish Hospital—in 1987.[1] The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This required an extensive series of full-thickness incisions through the walls of both atria, a median sternotomy (vertical incision through the sternum), and cardiopulmonary bypass (heart-lung machine; extracorporeal circulation). After the introduction of the initial procedure, a series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. It was quite successful in eliminating AF but had drawbacks as well.[2] The Cox maze III is sometimes referred to as the "traditional maze", the "cut-and-sew maze", or simply the "maze."

During the past 10 years, several energy sources, such as unipolar radiofrequency, bipolar radiofrequency, microwave, laser, high-intensity focused ultrasound, and cryothermia, were incorporated into various devices in order to create some of the lesions of the Cox maze III procedure without actually cutting into the atrial walls. Microwave and laser therapy have both been withdrawn from the market, but the other devices continue to be utilized to treat AF surgically.


  1. Cox J, Schuessler R, D'Agostino H, Stone C, Chang B, Cain M, Corr P, Boineau J (1991). "The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure.". J Thorac Cardiovasc Surg. 101 (4): 569–83. PMID 2008095.
  2. Prasad S, Maniar H, Camillo C, Schuessler R, Boineau J, Sundt T, Cox J, Damiano R (2003). "The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures.". J Thorac Cardiovasc Surg. 126 (6): 1822–8. doi:10.1016/S0022-5223(03)01287-X. PMID 14688693.
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