Are You a Candidate for Mini Maze?
If you think that the mini maze procedure (minimally-invasive surgical ablation) makes sense for you, how would you know if you are a candidate for it? Here are general guidelines based on input from a number of surgeons as to how they determine who is a candidate for the mini maze procedure.
- Confirmed diagnosis of atrial fibrillation
- Age between 18 and 80 — some over 80 are also good candidates
- Failed rhythm or antiarrhythmic drugs and/or rate control drugs, or intolerant to them
- Intolerance to warfarin or Coumadin®, or unable to maintain proper INR levels
- Not morbidly obese
- No previous open-chest procedure (heart or lung)
- Able to provide written informed consent
The HRS Consensus Statement recommends that standalone surgery for atrial fibrillation should be considered for atrial fibrillation patients who are symptomatic and "who prefer a surgical approach, have failed one or more attempts at catheter ablation, or are not candidates for catheter ablation."1
While those with paroxysmal atrial fibrillation have the best chances of success with the mini maze procedure, those with persistent and longstanding persistent atrial fibrillation (the latter is sometimes referred to as chronic or permanent atrial fibrillation), have recently had good results as well.
If you are considering the mini maze procedure, arrange a consultation with the surgeon to understand the procedure and get all of your questions answered. You should discuss your overall health and medical history, along with your heart and afib history, in order to determine if you are a good candidate and can thus expect a good outcome.
Preparing for the Mini Maze Procedure
If you meet the surgeon's criteria, a pre-surgery evaluation typically involves several of these tests:
- Complete physical
- Electrocardiogram (ECG)
- Stress test or nuclear stress test
- Chest X-ray
- Computed tomography (CT) scan
- Holter monitor
- Transesophogeal echocardiography (TEE)
- Blood work
From these results, you and your surgeon will decide if it's a "go," and if so, get you on the surgery schedule. For Mellanie True Hills, founder of StopAfib.org, who had an early mini maze procedure, once the tests were complete it was just a matter of choosing the timing for surgery. She selected a Tuesday, with the intent of going home by Friday morning. Ten days after her tests, she was in surgery. Today, however, it is probably necessary to schedule farther in advance.
Once you're scheduled, then you'll begin your pre-surgery preparations. Plan to discuss with your surgeon what to do and not do before surgery. Expect to have some pre-surgery tests a few days in advance, including blood work and checking your INR level if you're on anticoagulants such as warfarin or Coumadin®. You may also meet with the anesthesia staff to determine how much and what anesthesia should be used.
Ask if your surgeon has any fact sheets or pre-surgery education to tell you what to expect during and after surgery, including follow up medical schedule, activity restrictions, and side effects to look out for, such as chest tightness, breathing difficulties, or unusual heart rhythms. Also ask about how best to deal with your incision sites after surgery and how to clear anesthesia from the body. Having this knowledge in advance will be very helpful after surgery, and it's best if you can procure any necessary supplies beforehand. If you're a female, see Special Concerns for Women Having Mini Maze Surgery to address special items you may want to procure beforehand.
Then it's simply a matter of preparing for your mini maze procedure. Generally you'll be told to stop all aspirin and anticoagulants for about five days beforehand, but this is an area that is evolving. Your surgeon will advise you on whether to continue or discontinue your other medications before surgery. You'll also be instructed not to have any food or drink for about 12 hours before surgery, or at least not after midnight the night before.
Also consider whether you'd like to have a living will, and if so, have it prepared and witnessed beforehand and take it with you to the hospital.
If medicine isn't managing and controlling your afib, you may wish to discuss surgical approaches or catheter ablation with your doctor. For more information, see Partnering with Your Doctor.
To learn more, see What to Expect During a Mini Maze Procedure.