Are you a Candidate for Mini-Maze Surgical Ablation (Closed Chest)
From interviews with atrial fibrillation patients we've noticed that you just don't have the time or patience for trying lots of different things, many of which probably won't work anyway.
About Atrial Fibrillation Patients
If you don't get relief from medication, electrical cardioversion, or catheter ablation, you will proactively seek out a solution. If you don't have other heart issues, you find that Mini-Maze surgery is very appealing. As an elective surgery it appeals to proactive patients like you who are looking to cure their afib, not just manage it.
You have very high expectations and you want all the facts up front and to know exactly what to expect so that you can proactively take charge of your condition and your recovery. And if you don't get the answers you need from cardiologists or electrophysiologists, you'll just refer yourself to a surgeon. We've seen that countless times.
We've found that as an atrial fibrillation patient, you value knowledge, education, and information, and will not relinquish control until you know all the possible outcomes and how to deal with them. This site was built with you in mind, to provide you with information and answers about your afib.
Are You a Candidate for Mini-Maze Surgery?
If you think that Mini-Maze surgical ablation makes sense for you and could cure your afib, how would you know if you are a candidate for it? Here are guidelines used by Dr. David Affleck, a cardiac surgeon, for determining candidates for minimally-invasive Mini-Maze surgery. 1
- Confirmed diagnosis of atrial fibrillation
- Age between 18 and 80
- Symptomatic
- Failed antiarrhythmic and/or rate control drugs, or intolerant to them
- Intolerance to warfarin (Coumadin®), or unable to maintain proper INR levels
- Not morbidly obese
- Patient able to provide written informed consent
If you meet these criteria and have also had unsuccessful catheter ablations, you are an appropriate candidate.1 Other surgeons have similar candidate criteria.
While those with paroxysmal afib have the best chances of success, candidates with persistent afib or permanent afib have recently had good results as well.
If you are considering this 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 for this surgery and can expect a good outcome from it.
Preparing for Mini-Maze Surgery
If you meet the surgeon's criteria, a pre-surgery evaluation typically involves many of these tests:
- Complete physical
- Electrocardiogram (ECG)
- Echocardiogram
- Stress test or nuclear stress test
- 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 the founder of StopAfib.org, who had early Mini-Maze surgery, 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 if you're on warfarin or Coumadin®, checking your INR level. 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 to best 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 surgery. Generally you'll be told to stop all aspirin and anticoagulants for about five days before surgery, but this is an area that is currently evolving and changing. Your surgeon will advise you on whether to continue or discontinue your other medicines 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.
To learn more, see What to Expect During Mini-Maze Surgery.
1 Affleck, David, MD, Guidelines to Consider When Referring Patients for Minimally-Invasive Surgical Ablation of AF, Western Cardiovascular Associates, Salt Lake City, UT.
