Atrial Fibrillation Ablation (for the treatment of paroxysmal atrial fibrillation)

About 2 million Americans suffer from atrial fibrillation (an intermittent irregular heart rhythm in the upper chambers of the heart) making it the most common irregular heart rhythm and the second most common cause of cardiac-related hospitalizations. During atrial fibrillation, abnormal electrical signals disrupt the heart's rhythm and cause the heart's upper chambers to quiver instead of contract normally. If left untreated, atrial fibrillation can lead to pooling or clotting of the blood within the upper chambers, increasing the risk of stroke.

Electrical impulses in your heart muscle (the myocardium) cause your heart to beat (contract). This electrical signal begins in the sinoatrial (SA) node, located at the top of the heart's upper-right chamber (the right atrium). The SA node is sometimes called the heart's "natural pacemaker." When the SA node releases an electrical impulse, it causes the atria to contract. The signal then passes through the atrioventricular (AV) node. The AV node sends the signal through the muscle fibers of the lower chambers (the ventricles), causing them to contract.

Any irregularity in your heart's natural rhythm is called an arrhythmia. Arrhythmias can be divided into two categories: ventricular and supraventricular. Ventricular arrhythmias occur in the heart's two lower chambers, called the ventricles. Supraventricular arrhythmias occur in the atria, which are the heart's two upper chambers.

Arrhythmias are further characterized by the speed of the heartbeats. A very slow heart rate, called bradycardia, means the heart rate is less than 60 beats per minute. Tachycardia is a very fast heart rate, meaning the heart beats faster than 100 beats per minute. Fibrillation, the most serious form of arrhythmia, is fast, uncoordinated beats, which do not pump blood.

Maze Surgery

Maze surgery is also called the Maze procedure. Surgeons perform Maze surgery to treat chronic atrial fibrillation (AF). AF is a fast, irregular heart rhythm where the upper chambers of the heart contract in an uncoordinated fashion. AF is dangerous because it may cause blood to pool in these chambers. The pooled blood can lead to clumps of blood called blood clots. A stroke can occur if a blood clot travels from the heart and blocks a small artery in the brain.

Maze surgery cures AF by creating a "maze" of new electrical pathways to let electrical impulses travel easily through the heart. The classical maze procedure required a breastbone splitting incision, and potential complications associated with open-chest surgery such as bleeding, infection, stroke and pneumonia kept this procedure from widespread use. 

Alternatively, with minimally invasive techniques, patients often avoid many complications such as long recovery and risk of infection often associated with open-heart techniques. The minimally invasive maze procedure is performed using robotic-assisted technology. During the procedure a few small incisions are made between the ribs, through which surgeons position a tiny camera and a catheter for performing the ablation. This catheter directs cryo-freeze or microwave energy to precise areas in heart tissue to interrupt the abnormal circuits that cause irregular heartbeat.

The robotic-assisted maze surgical procedure provides a permanent solution to atrial fibrillation and has a much higher likelihood of success (80% robotically vs. 40% percutaneously) since the surgeon is able to actually see the area to be ablated.

Benefits to You

With traditional Maze surgery, you can expect to stay in the hospital for 5 to 7 days or longer, including at least 1 to 2 days in the Intensive Care Unit (ICU). It usually takes about 2 months to recover from Maze surgery. You would have some pain where your chest was opened, and you would feel more tired than usual. You would be able to go back to work after about 3 months. Most patients find that they have fully recovered within 6 months of surgery.

The robotic-assisted Maze surgery offers a much shorter hospital stay and a three week recovery time. If you are considering having your heart surgery at St. Luke’s, Methodist, or Memorial Hermann, please contact us.