Mini Maze Procedure (Surgical Ablation)
Not everyone with atrial fibrillation needs to have open heart surgery. In fact, about one-third of afib patients don't have any other heart issues. For most, the open chest procedure just doesn't make sense, especially due to the long and difficult recovery period.
Fortunately, if you have just atrial fibrillation and no heart valve issues, there is a minimally-invasive version of the maze procedure. It's called the mini maze procedure. It evolved from the Cox Maze III procedure, which is a "cut-and-sew" procedure, and is performed on a beating heart without opening the chest.
This procedure is done by a cardiothoracic surgeon. It takes only a few hours, and doesn't require the large incisions in the sternum that are necessary for open-heart surgery. Thus, recovery time is much shorter and easier, and most patients are afib-free afterwards. The mini maze procedure offers a way to stop the irregular heartbeats and heart palpitations without the long and difficult recovery for open-heart surgery. It is a potential atrial fibrillation cure.
While patients with paroxysmal atrial fibrillation have been considered the best candidates for the mini maze procedure, recent enhancements have also yielded success with persistent and longstanding persistent atrial fibrillation, sometimes referred to as chronic or permanent atrial fibrillation.
To get to the heart, the surgeon makes three or four small incisions on each side of the chest, and through these incisions places surgical instruments, an ablation device, and a thoracoscope. The thoracoscope (endoscope) is a camera and direct vision device that allows the surgeon to see the heart inside of the chest.
A surgical ablation energy source is used to create a conduction block that isolates the pulmonary veins and stops the chaotic electrical signals from disrupting the heart. While in there, the surgeon treats the Ligament of Marshall and nerve bundles that are called the ganglionic plexi, and removes or clamps off the left atrial appendage to reduce the risk of blood clots and stroke.
Recently, outcomes have improved for those with persistent and longstanding persistent atrial fibrillation through new lesions, including lesions in the roof and floor of the heart, a lesion connecting to the mitral annulus (a fibrous ring around the mitral valve), and isolation of the coronary sinus and of the superior vena cava just above the right atrium. New tools and procedures have improved ablation effectiveness in these thicker and hard-to-access heart tissues. Finally, a "four box" verification technique has been added to confirm the electrical isolation of all sources of atrial fibrillation in order to increase the potential for staying in normal sinus rhythm. This newest version of the mini maze procedure is called the Total Thoracoscopic Maze.
To learn more about this latest version of the mini maze procedure, read about the Total Thoracoscopic Maze or see Surgeon Discusses Evolution and Future of Atrial Fibrillation Maze Procedure to watch a video of an actual mini maze procedure.
A recent minimally-invasive variation is the Paracardioscopic Ex-Maze, which involves placing a small circular incision in the abdomen and going through the diaphragm to access the back of the heart.
One of the newest frontiers in afib treatment is a very encouraging trend that has evolved out of the collaborations between electrophysiologists and cardiothoracic surgeons, especially at integrated afib centers. Since there are advantages to both the mini maze procedure and catheter ablation, the newer convergent procedures combine the best of the mini maze procedure and catheter ablation in the same operation and offer a lot of promise.
It is important to be aware that the US Food and Drug Administration (FDA) has not approved most surgical devices specifically for atrial fibrillation treatment, though clinical trials are underway to gain this approval. However, many of these tools have been FDA-approved for use on "cardiac tissue" and doctors are at liberty to use the tools that they deem appropriate and safe for the treatment of atrial fibrillation patients.