Surgical Treatment Options for Atrial Fibrillation
There are multiple surgical options for patients with atrial fibrillation . These range from minimally invasive video assisted (VATS) ablation, to concomitant (in combination with other cardiac surgery procedures like coronary artery bypass graft, or CABG), to stand alone surgical ablation. Surgical treatment options are often reserved for patients with AFib that does not improve with medications or other treatments. A surgical approach may also be recommended if AFib symptoms return after other treatments have been utilized.
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Patients who do not require other heart procedures and/or are unable to tolerate open-heart surgery, may be eligible for a minimally invasive procedure called a convergent procedure. This novel, advanced option is performed using a combination of surgical and catheter-based interventions, and results in smaller incisions. In this procedure, the cardiac surgeon and electrophysiologist work as a team to treat AFib, combining minimally invasive video assisted (VATS) ablation with catheter ablation techniques. Results have proven to correct AFib in up to 85 percent of patients.
Surgical Maze Procedure
Surgical ablation is the original, traditional surgical option for treating AFib. The Cox-IV Maze procedure is done under general anesthesia as open-heart surgery, with the use of a heart-lung machine. It is the preferred method of AFib treatment for patients who need additional heart procedures such as heart valve repair, replacement or coronary revascularization (CABG). Traditional Cox-IV Maze surgery has proven to correct AFib in up to 90 percent of patients, many of whom can stop taking blood thinners several months after the procedure.
How is Maze Surgery Done?
Once the surgeon opens the patient’s chest to access the heart, the patient is placed on the heart-lung machine. Special tools are used to apply radiofrequency (hot) or cryo (cold) energy to the upper chambers of the heart (atria). These energy sources create lines of scar tissue in the heart, which block the triggers that cause AFib.
During the procedure, the surgeon also closes the left atrial appendage (LAA) a small pouch of the left atrium that is a common location for the formation of blood clots in people with AFib. Closing the LAA has been proven to reduce the risk of stroke due to AFib after surgery, by more than 90 percent.
How to Prepare for a Surgical Ablation Procedure
In addition to taking a comprehensive medical history and performing a complete physical exam, your surgeon will order a variety of tests to ensure you are healthy enough to undergo surgery. These may include:
- Blood tests
- Chest X-ray
- Electrocardiogram
- Echocardiogram
Once your procedure has been scheduled, your surgeon will provide you with detailed instructions about how to prepare, including when to stop eating and drinking, which medications to stop taking and when. It is very important to follow the doctor’s instructions exactly to ensure your safety.
Recovering from AFib Surgery
The surgery itself typically takes 2-4 hours. You will be closely monitored as you wake up from the anesthesia and moved to the Intensive Care Unit (ICU), typically for at least one or two days. The total expected hospital stay is overnight for the concomitant hybrid (convergent) procedure, or can be a week or longer after the traditional open Maze surgery.
Complete recovery from AFib surgery usually takes 8-10 weeks. During this time period, you may feel more tired than usual, which is normal. Your doctor will prescribe pain medications, if necessary, along with instructions about how to care for the incision to prevent infection.
If your heart rate is too slow after surgery, your doctor may recommend that you have a pacemaker implanted.