Mini Maze Surgery for Atrial Fibrillation
Darryl M. Hoffman, MD, FRCS

Atrial Fibrillation (AF) is the most common heart rhythm abnormality. Atrial fibrillation affects over 2 million Americans, especially as people age. Once thought to be a nuisance condition, atrial fibrillation is now known to be very dangerous, causing one of every seven strokes. Atrial fibrillation can also be deadly: the risk of dying of a heart condition is doubled in patients with atrial fibrillation, and efficient pumping of blood by the heart is reduced in every atrial fibrillation sufferer.

Standard management of atrial fibrillation uses medications to slow down the heart rate, resulting in a decreased pumping efficiency. The blood has to be "thinned" with Coumadin (warfarin), which interferes with normal blood clotting, and prevents half, but not all of the strokes caused by atrial fibrillation. Unfortunately, coumadin can cause serious side effects, most importantly bleeding, which can be very dangerous.

Another strategy is to use medications to restore normal sinus rhythm, which will prevent stroke, maintain efficient pumping of the heart, and avoid the need for blood thinners. Unfortunately, the best available antiarrhythmic drugs fail in 45% of cases and also cause some serious side effects which cancel the benefits from recovering sinus rhythm.

In the vast majority of patients, atrial fibrillation is caused by an abnormal electrical impulse which starts in cells in one of the four pulmonary veins, which return oxygenated blood from the lungs to the left atrium. Insulating the heart electrically from the four veins prevents the spread of this abnormal electrical signal from the cells of the pulmonary veins to the cells of the atrium, and is an effective cure for atrial fibrillation.

Surgical therapy for atrial fibrillation (the Maze procedure) has been offered for 20 years, but it could be a long, complicated procedure that required separation of the breastbone and use of cardiopulmonary bypass (heart-lung machine). Fortunately, Beth Israel cardiac surgeons now offer a minimally invasive cardiac surgery operation called Minimaze, which provides safe and easy access to the heart through a two inch incision between the ribs, and does not require separation of the breastbone or use of a heart-lung machine.

During the Mini-maze procedure, our heart surgeons, going between the ribs, apply a special clamp, with full visibility, to the area causing the arrhythmia. A brief burst of measured radiofrequency energy passes only between the jaws of the clamp, and creates the needed circular insulation line between the pulmonary veins and the atrium, thus blocking the pathway for the abnormal electrical impulse. Also during Minimaze, through the same small incision, specialized electrical testing locates nerve tissue collections which lie in the fat on the surface of the heart. These are interrupted with no ill effects to the heart, but to the great benefit of protecting against atrial fibrillation.

In patients who are at high risk for stroke, Minimaze also involves the removal of the left atrial appendage. The left atrial appendage is an outpouching where clots can form, and these clots may break off and cause a stroke. This unnecessary but dangerous part of the atrium is removed under direct vision during Minimaze using a special stapler.

The Minimaze operation takes around three hours and is safe and highly effective. Most patients stay in the hospital three days and can return to full activity two weeks after the Minimaze procedure. Most can be gradually weaned off of antiarrhythmic and blood thinning medications in three months.

To schedule a consultation for the Minimaze procedure with Dr. Darryl Hoffman, call (212) 420-2584.

Beth Israel Medical Center
Division of Cardiac Surgery
317 E. 17th Street, 11th Floor
New York, NY 10003
(212) 420-2584