Surgical Treatment

Atrial Fibrillation Maze has become an increasingly viable treatment option for individuals with A-fib. Maze is a surgery for atrial fibrillation that offers the prospect of a permanent cure. The Aspirus Heart & Vascular Institute is one of a select few cardiac centers in the United States specializing in the Maze procedure for atrial fibrillation. 

Patients who have surgery can expect an 85-90 percent success rate at two years with a single surgical atrial fibrillaton Maze procedure. This is a superior success rate for paroxysmal or persistent A-fib than experienced with catheter ablation.

At this time, surgery for atrial fibrillation is separated into two different surgical techniques – the Mini-Maze and the Full Maze procedure. The cardiac surgeon will help you decide during the initial consultation which procedure will have the best results.

Mini-MAZE

surgery for atrial fibrillationThe minimally-invasive atrial fibrillation Maze (Mini-Maze) is used for treatment of paroxysmal A-fib.  During the Mini-Maze procedure, the surgeon accesses the heart through small incisions under the arm and between the ribs. Through these small incisions the surgeon places surgical instruments, an ablation device, and a thorascope. The thoracoscope is a camera that allows the surgeon to see the heart inside of the chest.

An energy source is transmitted through the ablation device which is used directly on the heart muscle to ablate (scar) the areas where the irregular signal starts. Scar tissue that is formed during the ablation, will prevent abnormal electrical impulses. The scar tissue interrupts the transmission of the abnormal signals that cause A-fib, thus allowing the heart to beat normally.

Additionally, the surgeon utilizes a special probe to map the autonomic nerve bodies on the surface of the heart that cause abnormal electrical signals in the heart. Once these areas are mapped, an energy source from the probe can be used to ablate these nerve bodies, further extinguishing the sources of the erratic heart beats from the atria. The surgeon conducts further testing to confirm that all potential sources of A-fib are isolated.

A final critical component of surgery is removal of the left atrial appendage. This finger-like structure or pouch is believed to be the primary location where blood clots form during A-fib. Data has shown that as many as 90 percent of the potentially stroke-causing clots found in the heart in association with A-fib are located in the left atrial appendage.

Thus, by removing the left atrial appendage, the risk of stroke is greatly reduced, making it much safer for the patient to be off blood thinning medication such as Coumadin. This entire surgery for atrial fibrillation is performed without stopping the heart or using the heart-lung machine, resulting in a highly effective procedure that is simpler and safer for the patient. The procedure lasts 2 to 3 hours and requires a 1- to 2-day hospital stay afterward. Most patients are able to return to normal activities in 1-2 weeks.

Full-MAZE

This surgery for atrial fibrillation is for patients who are in persistent A-fib and for patients who also need heart surgery for coronary artery disease or valve disease. The chest is opened through a chest incision called a sternotomy. A Full atrial fibrillation Maze procedure involves all the components of the Mini-Maze, including more extensive lesions to ablate and scar the extra pathways involved in persistent A-fib and even atrial flutter. The Full Maze procedure uses a combination of surgical incisions and an energy source to ablate (scar) the problem cells and create scar tissue, creating a “maze” in the heart. Afterward, the electrical impulse of the heart can only travel down one pathway thus restoring a normal rhythm in the heart. The left atrial appendage is removed just as it is in the Mini-Maze.

This procedure takes 3-4 hours and entails 2-3 days in the hospital.  Patients should expect a 4-6 week recovery period.

AtriClip

The AtriClip Gillinov-Cosgrove Left Atrial Appendage Exclusion device is an implant used during surgery for atrial fibrillation that clamps off blood flow to the appendage and prevents blood from pooling. By cutting off the blood flow, the chances of a clot forming in this high-risk area and causing a stroke are greatly reduced. The AtriClip blocks blood flow to the appendage more effectively than other techniques and is designed to be implanted from the outside of the heart, avoiding contact with circulating blood. The Aspirus Heart & Vascular Institute is one of only a handful of centers in the United States utilizing this device.  Read more about the AtriClip Device.

What to expect after surgery

While recovering from surgery for atrial fibrillation, it is not unusual to continue to experience atrial fibrillation. During this time, patients continue taking their blood thinners and medications for A-fib. Patients should expect to wear a cardiac monitor for 2-3 weeks at least once, and possibly twice, during the six months after surgery to document normal heart rhythm.  By three to six months, 85-90 percent of patients experience a regular heart rhythm off anti-arrhythmics and are able to have their Coumadin safely discontinued.

Atriclip for Atrial Fibrillation

Featuring John Johnkoski, MD

The Atriclip is a progressive new surgical device that helps eliminate the risk of stroke in patients with atrial fibrillation.