Surgical Options

The “classic” or “cut and sew” Maze procedure is a traditional surgical approach to treating atrial fibrillation. During the classic Maze procedure, multiple incisions are made in the right and left atria (the upper chambers of the heart) to isolate abnormal electrical signals or impulses that cause atrial fibrillation. The left atrial appendage (a pocket-like section in the left atrium), often a source of blood clot formation and stroke, is completely removed. The incisions are then sewn closed.

As the incisions heal, they form a pattern of scars. These scars redirect the abnormal electrical signals that cause atrial fibrillation. Because the incisions are made from the inside of the heart, patients undergo “open heart surgery” and during surgery are placed on a heart-lung or “bypass” machine. The heart-lung machine temporarily takes over the function of the heart and lungs during surgery.

The classic Maze procedure may be performed on those patients whose only cardiac condition is atrial fibrillation, or in conjunction with surgery for other heart conditions. Frequently patients that undergo the classic Maze procedure have tried multiple treatments for atrial fibrillation including medications, cardioversion and catheter ablation without success.

Minimally Invasive Surgical Options

Total thoracoscopic modified MAZE (TTm MAZE) and Convergent are minimally invasive procedures. They are used to treat chronic, long-standing or persistent atrial fibrillation.

• TTm Maze may be an option for patients who still have symptoms after multiple catheter ablations. Convergent may be an option for patients early in their treatment.
• TTm Maze and Convergent are staged and require two steps. In the procedures, a cardiac surgeon gains access to the heart through small incisions. Then, they create scars on the outside of the heart to disrupt the irregular flow of electricity that causes atrial fibrillation. Six weeks later, a cardiac electrophysiologist performs a catheter ablation. They use radiofrequency energy to create scars on the inside of the heart to disrupt the irregular flow of electricity that causes atrial fibrillation.
• Both TTm Maze and Convergent offer a “one-two punch” to eliminate atrial fibrillation.

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