Currently, many patients with atrial fibrillation are candidates for minimally
invasive surgical ablation. Approaches include keyhole surgery or a completely
endoscopic approach. In both techniques, the procedure includes isolation
of the pulmonary veins and excision (removal) of the left atrial appendage.
Lines of conduction block (scar tissue) are created on the heart using radiofrequency
or/and microwave energy. These lines of conduction block interrupt the abnormal
circuits that cause atrial fibrillation, enabling restoration of normal
sinus rhythm.
The traditional Maze procedure (Cox-Maze III procedure),
developed by Dr. Jim Cox, has been the gold standard for treatment of atrial
fibrillation. The surgery involves creating precise incisions in the right
and left atria to interrupt the conduction of abnormal impulses and to direct
normal sinus impulses to travel to the atrioventricular node (AV node) as they
normally should.
The reduced invasiveness of the Mini-Maze procedure gives
more patients an effective treatment option for this troublesome condition,
avoiding the need for a sternal incision and the use of the
heart-lung machine. Patients have this procedure can expect to be discharged
within 2-3 days and resume normal activities within 1-2 weeks.
The Maze procedure is highly effective in restoring sinus
rhythm generally reported in the range of 90-100%. Mini-maze
success rates vary by center but long-term follow-up suggests about 70%
of patient will have long-term freedom from atrial fibrillation.
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