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Atrial Fibrillation Surgical Treatment

Since 1987, when Dr. James Cox and colleagues first introduced the Cox-Maze Procedure, the science and technology behind the surgical treatment of atrial fibrillation (read a case study - Atrial Fibrillation surgery) has advanced dramatically. Today, there are a variety of surgical procedures that are available for the treatment of atrial fibrillation, and Emory's Cardiothoracic Surgeons are knowledgeable about and skilled in them all. Watch a video of the surgery.


Cox-Maze Procedure

The traditional Cox-Maze procedure, long considered the gold standard for surgical treatment of atrial fibrillation, is an open-heart surgery performed with the heart-lung machine (pump that sends blood and oxygen to the body while the heart rests).

The Cox-Maze procedure usually involves:
• Opening the chest through the breastbone (sternotomy) to gain access to the heart
• Creation of incisions in the top chambers of the heart (the atria) to form "lesions" that interrupt the electrical pathway that was causing the irregular heart rhythm
• Removal of extra heart tissue if the top chambers of the heart are enlarged
• Removal or closure of the left atrial appendage (small lip of extra tissue on the left side of the heart where it is thought that many stroke-causing blood clots form)
• The Cox-Maze procedure is typically an option for atrial fibrillation patients who are undergoing heart surgery for an additional heart problem (for example, surgery for heart valve disease or coronary artery disease, also called a "concomitant" procedure). Depending on patient characteristics, the Cox-Maze procedure is also an option for patients who do not need other heart surgery but who meet the criteria for the Cox-Maze procedure.

Modified-Maze Procedure

The Modified-Maze procedure uses an alternate energy source instead of incisions to create the same "lesions" made in the Cox-Maze procedure. Alternate energy sources such as radiofrequency, cryothermy (freezing), microwave, laser, and ultrasound have been used by Emory cardiothoracic surgeons to create the "lesions" that block the irregular electrical pathways of atrial fibrillation.

The Modified-Maze procedure usually involves:
• Opening the chest through the breastbone (sternotomy) to gain access to the heart
• Use of the heart-lung machine in some cases
• Placement of precise "lesions" in the top chambers of the heart to block the irregular electrical pathways of atrial fibrillation
• Removal or closure of the left atrial appendage (small lip of extra tissue on the left side of the heart where it is thought that many stroke-causing blood clots form)
• The Modified-Maze procedure is typically an option for atrial fibrillation patients who are undergoing heart surgery for an additional heart problem (for example, surgery for heart valve disease or coronary artery disease, also called a "concomitant" procedure). Depending on patient characteristics, the Modified-Maze procedure is also an option for patients who do not need other heart surgery but who meet the criteria for the Modified-Maze procedure.

Mini-Maze Procedure

The Mini-Maze procedure is a cutting-edge minimally invasive surgery recently developed for the treatment of atrial fibrillation. Emory surgeons perform this surgery through three tiny incisions (approximately 1.0-1.5 centimeters each) on each side of the chest. This allows the surgeon access to the heart without having to open the breastbone and without having to use the heart-lung machine.

The Mini-Maze procedure involves:
• Use of specialized instruments and cameras to help the surgeon guide the alternate energy source device into place
• Placement of precise "lesions" in the top chambers of the heart to block the irregular electrical pathways of atrial fibrillation
• Removal or closure of the left atrial appendage (small lip of extra tissue on the left side of the heart where it is thought many stroke-causing blood clots form)
• The Mini-Maze procedure is an option for atrial fibrillation patients who do not need heart surgery for an additional heart problem, or those without any other heart problems who have what is called "lone" atrial fibrillation. Many of the patients who undergo the Mini-Maze procedure have previously undergone one or more catheter ablation procedures for atrial fibrillation and/or are unable to manage their atrial fibrillation with medications.
Watch a video on the Mini-Maze procedure. This video shows Dr. John Puskas performing a thoracoscopic Mini-Maze Procedure for the treatment of atrial fibrillation. This minimally invasive procedure is performed through three small incisions on each side of the chest and involves the application of radiofrequency energy to treat the irregular heart rhythm. The video includes footage of the incision locations and size, radiofrequency ablation lesion placement, removal of the left atrial appendage for the prevention of stroke, and administration of pain medicine at the end of the procedure. Warning: This video contains graphic imagery of a surgery.
• Download Dr. John Puskas' case report (PDF 152 KB) published in the Annals of Thoracic Surgery describing the mini-maze procedure.

Atrial Fibrillation