Heart & Vascular Center

Heart and Vascular (Cardiology)

#14 in the Nation
by U.S. News & World Report

Cox Maze Procedure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common type of irregular heart rhythm, affecting more than two million Americans. The likelihood of atrial fibrillation increases with age, especially between the ages of 60-80. Although some people with atrial fibrillation may not experience symptoms, others face serious illness and effects, including chest palpitations, difficulty exercising, shortness of breath, poor blood circulation, heart failure, and risk of developing a blood clot and stroke.

Gold Standard of Treatments

Medical and surgical treatments can restore a normal heart rhythm, relieve symptoms and reduce the risks of stroke and heart failure. The Cox-Maze procedure is the gold standard treatment for atrial fibrillation. This procedure was first developed by Dr. James Cox at Barnes-Jewish Hospital in 1987 and is now performed around the world.

Since then, advancements in atrial fibrillation surgery at Washington University School of Medicine have simplified the approach to performing this operation. In 2002, Dr. Ralph Damiano, a Barnes-Jewish & Washington University Heart & Vascular Center surgeon, introduced the use of waves of energy to replace many of the incisions typically made with the Cox-Maze procedure. Since its development, our cardiac surgeons have seen patients from around the globe with atrial fibrillation, and our success rates with the procedure are the best in the world.

The Cox-Maze procedure is used to stop the irregular electrical impulses that cause atrial fibrillation. In this procedure, surgeons make small incisions in the heart, creating a planned “maze” of scar tissue. This scar tissue serves as barriers, guiding irregular cardiac electrical signals back to more normal pathways. In doing so, the Cox-Maze procedure restores a regular heartbeat again.

During the Cox-Maze operation, the pulmonary veins are also completely isolated. The left atrial appendage (LAA), which is a common source of blood clots, is either sewn closed or completely removed during surgery. This step greatly reduces the risk of stroke in atrial fibrillation patients.

The Cox-Maze procedure has a success rate of more than 90 percent. Most patients are hospitalized an average of 8-10 days. Patients usually are in the intensive care unit for two days and the remainder of the time is spent on the step-down unit. In general, the recovery is complete about 4-6 weeks after surgery. A minimally invasive approach is now available which significantly reduces the incision size and the length of the hospital stay.

A person suffering from atrial fibrillation should consider the Cox-Maze procedure or the minimally invasive Cox-Maze procedure if he or she has the following:
  • symptoms that have not responded to medical treatment 
  • recurrence of atrial fibrillation symptoms despite having undergone catheter-based ablation therapy 
  • an upcoming open-heart procedure for either coronary artery disease or heart valve disease
  • an inability to use long-term anticoagulation (blood thinners, such as Coumadin/warfarin) because of a high risk of bleeding
  • chronic or persistent atrial fibrillation and a history of stroke despite adequate anticoagulation (thinning of the blood)
  • tachycardia (rapid heartbeat)-induced cardiomyopathy (heart enlargement), which can lead to heart failure
To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call .

Treating Atrial Fibrillation

Find out how we're advancing treatments for atrial fibrillation like the maze procedure and catheter ablation.


Sign Up Today for Free e-Newsletters

Find a doctor or make an appointment:
General Information: (314) 747-3000
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
© Copyright 1997-2016, Barnes-Jewish Hospital. All Rights Reserved.