Additional Surgical Procedures

Treating Atrial Fibrillation with Surgery

What are the remaining options used to treat atrial fibrillation, and how is the decision usually made?

Medicines to treat rapid and irregular heartbeats work for many people. But they don’t work for everyone, and they may cause side effects in some people. Electrical cardioversion and catheter ablation procedures also help a number of AFib patients to reach important treatment goals and manage symptoms to a satisfactory level.  

However, in many people, the atrial fibrillation continues to return despite repeated treatment attempts.  This can be a very frightening and frustrating situation for many people who would like to get the problem under control.

What are the more in-depth surgical options?

There are procedures that have been very helpful and have provided long-term success to others who have recurring problems with AFib.  Here are some brief descriptions of these procedures with additional information provided at the links below.

An Open-Heart Ablation with Maze-like Atrial Repairs

Maze heart surgery is a complex process that may provide a cure for atrial fibrillation by interrupting the electrical signals causing the irregular heart rhythms. These procedures can restore a regular heart rhythm following recovery. For a small percentage of patients, the need for a pacemaker will arise during or after the procedure.

  • Cox maze (III) procedure is an open-heart surgery done by a cardiothoracic surgeon using a traditional "cut-and-sew" procedure to scar the tissue. It is considered the most effective for long-term relief of atrial fibrillation symptoms but is highly complex and rarely done today. Today’s patients who need surgery are more likely to be offered the Cox Maze IV (called simply a maze procedure) or a mini maze as described below.
  • Maze procedure (Cox maze IV) is a surgical ablation done by a cardiothoracic surgeon. It uses the same open-heart procedure as Cox maze III, but uses an energy source to scar the tissue rather than to remove it or scar it with traditional “cut-and-sew” techniques. This procedure may be done as a standalone procedure, but is more typically done along with other heart surgery, such as a valve repair or a bypass, which is called “concomitant surgery”.
  • Mini-maze procedure is a minimally-invasive surgical ablation that also uses an energy source to scar the tissue, like the Maze procedure above.  However, the mini-maze doesn't require the surgeon to fully open the chest, so it typically offers a shorter recovery time. The sternum remains in-tact, and the procedure is done using video-guided technology and robotically-assisted surgical tools. It is less invasive than the other surgery options and is slightly more invasive than catheter ablation.

The journey to finding a long-term workable solution for atrial fibrillation can be complex for both patients and providers. Through effective teamwork and a positive, persistent attitude, we hope your commitment to wellness pays off with a long-term solution

Recent Discussions From The Providers Office Forum
Wayne avatar

I am a 78-year old male with persistent AFIB for about the last 20 years with only occasional instances of racing heart rate.  In 2010, I had open heart surgery to replace the aortic valve along with a triple by-pass and a cryo-maze procedure to correct the AFIB (the maze procedure only fixed the AFIB for about a month).  In my opinion, I have been doing very well and see my personal physician and cardiologist twice a year.  I keep a good record of my vitals on a weekly basis.  Every so often (2 to 3 times a year) I note that my heart rate (normally 68-70 BPM) while sleeping will dive to the 40's and 50's and stay at that lower rate for a week or two.  Neither of my doctors seem concerned about this.  During my discussion last week with my cardiologist, while discussing this issue, he stated that AFIB can result in low heart rates as well as high heart rates and talked about a pacemaker if and when the low heart rate situation warrants it.  I did not know that AFIB could cause low heart rates and would like to hear if others on this forum have expeienced low heart rates as a result of AFIB.  Thanks.

Trish avatar

Still sifting through the reams of info on ablation. Seems no real consensus on anything except that the centers that do the most have the best outcomes. Saw my lovely, warm dr yesterday for consult on ablation...when or if to do. He is outstanding and I was ready to pull the trigger on the procedure when he told me that since he is at a teaching hospital, his students(fellows) do the ablation with his oversight and correction when needed. I should have realized this but did not. So...the centers that do lots of ablations without student participation narrows the field considerably and let's out some of the major players. Please share any experiences. I am ready and will to travel but would prefer Miami/NYC area. Also, anyone out there have ablation at a teaching hospital?


Deb M avatar

I am going into the hospital next Wednesday for "tikosyn load". My doctor's office is not very forthcoming with information. Can anyone tell me what to expect? How is the load done and monitored? Is the load constant through IV or only at particular times? Do you have to actually lay in a bed for 3 days or can you get up and move around? Can you shower? What should you take to the hospital with you? Were you able to have visitors? How long before you can resume normal activies when you return home? Has being on this medication changed your life style?I would appreciate any advice anyone has. Thank you.

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