Surgical options for a-fib can include a minimally invasive approach similar to traditional open surgery. A full maze for a-fib would be offered in combination with valve surgery or coronary artery bypass grafting. Patients not requiring traditional, open surgery can benefit from the real advances of the mini maze within the last decade. Aspirus is unique and one of the few centers in the U.S. offering this approach.
An advantage of surgery versus catheter based ablation, though not as minimally invasive, is a higher success rate with single intervention and better chance being off anticoagulation and antiarrhythmic therapy.
The minimally invasive atrial fibrillation Maze (Mini Maze) is used alone for treatment of paroxysmal A-Fib. It can also be used in combination with catheter based ablation (Hybrid Mini Maze) for persistent A-Fib. During the mini Maze surgery, the surgeon accesses the heart through small incisions under the arm and between the ribs. It is significantly less invasive than the traditional open heart surgery. In addition to avoiding the pain and trauma of sternotomy and rib spreading, this may provide you with additional benefits, such as:
- Less risk of infection
- Less blood loss and need for blood transfusion
- Shorter hospital stay
- Significantly less pain and scarring
- Faster recovery
- Quicker return to normal activities
A variety of minimally invasive surgical instruments are used to create a systematic pattern of scars outside the heart. This pattern of scares or lesion sets will prevent abnormal impulses which cause irregular heartbeats from reaching the heart.
Additionally, the surgeon utilizes a special probe to map the autonomic nerve bodies. This same probe is then used to scar the nerve bodies, further extinguishing the sources of erratic heart beats. The surgeon conducts further testing to confirm that all potential sources of A-Fib are isolated.
A final critical component of surgery is the 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 stoke 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 3-4 hours and generally requires 1 overnight say in the hospital.
This surgery is for patients who are in persistent A-fib. 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 involves surgical incisions and radio frequency energy source and cryo to freeze the 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 excluded just as 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 is a device used in the minimally invasive Left Atrial Appendage Exclusion (LAAE). It’s designed to reduce risk of stroke for patients unable to be on anticoagulation. The procedure is not designed to get patients into normal rhythm. Expected procedure time is 45 minutes with plan to go home the following day.
What to expect after surgery
While recovering from surgery for atrial fibrillation, it is not unusual to experience several weeks of a-fib. This occurs due to the inflammation of the heart and pericardial sack around the heart, but resolves within a few weeks. Patients are not generally hospitalized for this. We at Aspirus use the most up to date monitors to monitor heart rate. Patients will receive an Implantable Loop Recorder (ILR) within a month of surgery to help get off of medications safely. The state of the art monitor stays in for 3-4 years
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.