Conclusion
The stand-alone CMP-IV had superior 5 and 7 year recurrence-free survival rates for patients with longstanding persistent AF compared to published reports of other surgical and catheter-based ablation techniques. The stand-alone CMP-IV was equally effective regardless of surgical approach, or number of previous catheter ablations. There were no mortalities and the rate of morbidity was low. On Fine-Gray regression, preoperative time in AF and early postoperative ATAs were predictive of late ATAs recurrence. Based on these findings, we recommend consideration of stand-alone CMP-IV for symptomatic patients with longstanding persistent AF who have failed catheter ablation or are poor candidates for catheter-based therapies.