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Surgical Treatment

Surgical ablation procedures are used for treating atrial fibrillation. They can be minimally invasive (through small cuts in the side of your chest) or traditional sternotomy (open-heart) surgery and may be combined with other surgical therapies such as bypass surgery, valve repair or valve replacement.

Hybrid maze, TT maze, mini-maze, modified maze or surgical ablation - the most advanced technique to treat A-Fib

Available at only a handful of U.S. medical centers, the surgical ablation, also called a Hybrid Maze, Modified Maze or Mini Maze procedure, involves the use of radiofrequency waves (modified electrical energy) to create precise scar lines on the heart’s surface. These scars redirect the erratic electrical impulses of A-Fib to follow a normal electrical pathway through the heart. Our surgeons use specially designed instruments to deliver the radiofrequency waves to the abnormal heart tissue.

Stage I – The first stage of the Hybrid Maze procedure takes approximately two to three hours and is termed the VATs Maze. VATs stands for video-assisted thoracoscopic surgery. Maze is a term used to describe the maze-like path created by your surgeon to redirect your heart’s electrical impulses. During the procedure your doctor will create four small incisions (1/2 inch) on each side of your chest between the ribs. This allows your surgeon to access your heart and use special tools, a small camera and radiofrequency waves to create precise pathways on the atria of your heart. These pathways block the irregular electrical activity and redirect the impulses through the “maze” resulting in a normal rhythm. Over the next three months, scar tissue forms on these pathways preventing A-Fib from recurring. Your surgeon will also ligate the left atrial appendage of the heart with a small titanium clip. This clip will remain in your chest but it is MRI-compatible and will not cause delays in airport terminals. The left atrial appendage, or “stroke center” of the heart, is a small pocket attached to the left atrium. In A-Fib, blood pools inside this appendage causing a greater risk of clots and stroke. By preventing blood flow in this small part of the heart, your risk of stroke should be significantly decreased.

Stage II - The second stage of the Hybrid Maze is catheter ablation. The majority of patients will go through this second stage of treatment. The ablation is performed by your electrophysiologist. Your doctor will enter the heart with a catheter through your femoral vein and perform small point ablation. Catheter ablation is done to create added scar tissue on the inside of your heart, therefore increasing success rates. This is done using radiofrequency waves (modified electrical energy). Your electrophysiologist has tools that are smaller and more precise than the surgeon. In essence, he is able to “spot weld” any leaks left by your surgeon.

Like many other heart surgeries performed here, surgical radiofrequency ablation can be done on a beating heart and does not require the use of a heart-lung machine.

This procedure is often referred to as the “Hybrid” procedure because it combines minimally invasive surgical techniques with the latest advances in catheter ablation. The two-pronged approach gives doctors access to both the inside and outside of the heart, helping to more completely block the erratic electrical signals that cause A-Fib.

Why experience and high volume matter

When selecting where to have your Hybrid Maze procedure, it is especially important to select a high-volume center. This means the physicians, nurses and staff are well versed on A-Fib and other cardiac conditions and are accustomed to treating the underlying causes of A-Fib such as valve disease. Our Arrhythmia Center is the highest volume center in the country for the Hybrid Maze and is a national surgical training site for surgeons.

Benefits of the procedure

The benefits of the procedure include the following:

  • Up to a 90 percent cure rate for A-Fib
  • Reduction in risks of blood clots and stroke
  • Few or no symptoms related to abnormal heart rhythms
  • Reduction or discontinuation of antiarrhythmic drugs
  • Most patients who have had the procedure report an ability to exercise more frequently and for longer periods of time
  • In some cases, the procedure will reduce the size of the atria, therefore lessening the risk for other complications such as heart failure

Minimally invasive approach offers added benefits

Additional benefits of the minimally invasive approach include:

  • No splitting of the breastbone (sternum)
  • Less scarring to heart tissue
  • No cutting of heart tissue
  • Significantly shorter operative time
  • Faster recovery than with a large chest incision
  • Less time spent in the hospital
  • Less pain, because the incisions are small
  • Minimal blood loss
  • Little scarring
  • Can be done on a beating heart eliminating the need for a heart-lung machine

Most candidates for this procedure have:

  • Been diagnosed with long-standing, or persistent A-Fib
  • Tried medications to control A-Fib
  • Failed a catheter ablation
  • Have a history of stroke and cannot take blood thinners
  • Experience debilitating symptoms that have changed their lifestyle

How is the radiofrequency approach better than the maze procedure?

You may have heard about the Maze procedure, a surgical approach to treating A-Fib that entails precise cutting of heart tissue to stop the abnormal heart rhythms. While this is an effective approach to treat A-Fib, it does pose greater risks and complications due to it being an open-heart procedure.

How is surgical ablation different from catheter ablation?

Catheter ablation is similar to surgical ablation in the sense that both procedures are performed for the same purpose, and they both use radiofrequency waves to treat abnormal heart rhythms. Catheter ablation involves the use of a catheter that is threaded through the leg and into the heart. The catheter is equipped with a device that delivers radiofrequency waves to the source of the arrhythmia. An electrophysiologist performs this procedure in a catheterization lab.

Learn more about what to expect prior to a surgical ablation.

Maze procedure

The maze procedure is a surgical treatment for A-Fib. The surgeon can use small incisions, radio waves, freezing, or microwave or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia. The scar tissue directs electric signals through a controlled path, or maze, to the lower heart chambers (ventricles).

The maze procedure is usually done during open-heart surgery. The maze procedure can cure A-Fib in most people. But because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and do not respond to medicine or other treatment.

The maze procedure is frequently performed with other necessary cardiac surgery, such as coronary artery bypass and valve repair or replacement.

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The Adventist Heart Institute values your privacy and handles your personal information with care. Your email address and information is secure, confidential and will not be sold to any third party sources.

AHI Rebrand