Surgery for atrial fibrillation is designed to restore patients to a regular heart rhythm, thereby reducing or eliminating the symptoms associated with atrial fibrillation. In addition, medications required to treat atrial fibrillation often can be stopped. Equally important, the long-term risk of stroke from atrial fibrillation can be reduced.
Which procedure is best?
The choice of procedure depends greatly on the different causes of atrial fibrillation. In those patients without any significant heart disease other than atrial fibrillation, a less invasive approach may be the best option. However, in those patients who have moderate or severe disease of the heart valves, moderate or severe coronary artery disease, or severe enlargement of the chambers of the heart, less invasive procedures are less likely to benefit them. In these patients, a combined open heart operation to address both the atrial fibrillation and the valve or coronary artery disease is the best approach.
Missouri Baptist Medical Center cardiac surgeons have treated atrial fibrillation surgically since 2001. More than 70 modified MAZE procedures have been performed. This is the most effective treatment for atrial fibrillation to date. This operation involves isolating the triggers of atrial fibrillation, and more importantly, disrupting the electrical pathways responsible for maintaining atrial fibrillation once it develops. It is an open heart operation requiring an incision through the breastbone and the support of the heart-lung machine while operating inside the heart. Discrete lesions or scar tissue is created within the walls of the heart at precise locations using, most commonly, radiofrequency energy. This scar tissue is electrically insulated and acts to disrupt the abnormal electrical circuitry responsible for atrial fibrillation. In addition, at the end of the procedure the left atrial appendage (where clot commonly forms) is removed or tied off to help reduce the long-term risk of stroke. In the largest experience of MAZE procedures, no patient developed any sign of stroke up to 10 years out from surgery.
The Mini-MAZE procedure is a less invasive version of the traditional, open chest MAZE procedure, and is typically conducted as a treatment for atrial fibrillation in patients without other cardiac disorders.
The mini- Maze procedure involves small incisions on both sides of the rib cage under the armpits to address both the right and left side pulmonary veins. Using video guidance, bipolar radiofrequency energy is used to isolate and remove the area of the heart tissue where the arrhythmias originate.
For more information on the MAZE procedures for treatment of atrial fibrillation or to schedule an appointment, call MoBap at 314-996-3627 or contact us online.
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