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Catheter Ablation
In this procedure, the doctor will thread several small catheters (tubes) through a vein in your groin and up to the chest to gain access to the inner heart. At least one catheter is pushed through the wall between the two upper heart chambers in order to gain access to the left atrium.
Electrodes at the end of the catheter can help the doctor detect the faulty electrical sites that are causing your heart to beat irregularly and too fast. Hot or cold energy is then used to scar (ablate) these sites. These scars can block the main electrical impulses causing your AF. Success rates can vary widely and sometimes the doctor may find it necessary to repeat the procedure. A catheter ablation procedure can take three to six hours but, on average, only requires a one to two night hospital stay.
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Concomitant (Open Chest) Surgical Ablation [Maze Ablation Procedure]
In recent years, surgical methods of treating AF have continued to develop. Since 2001, more than 40,000 patients have had this procedure, often called a Maze. It has been proven effective for a wide range of AF patients, even some with chronic AF. But it is also an invasive procedure, requiring open heart (concomitant) surgery and often a heart-lung bypass.
You and your doctor may want to consider this option if you have AF and need open heart surgery for another reason such as bypass surgery or a valve repir or replacement.
During this surgery, the surgeon will use instruments to identify the faulty electrical sites in your heart causing it to beat irregularly and too fast. Then an instrument with a heat source will be used to create precise scars, or ablations, on those spots. These scars will block the abnormal electrical impulses which cause AF and can return your heart to a normal rhythm. The surgeon may also create the necessary ablations that can block the abnormal electrical impulses causing your AF.
Additionally, many surgeons will remove or close off a small cul-de-sac-shaped pouch on the heart (the left atrial appendage) believed to be the primary site where stroke-causing blood clots form during AF.
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Minimally Invasive Surgical Ablation [Mini Maze Ablation Procedure]
For people who suffer from AF, but are otherwise fairly healthy, a minimally invasive Maze procedure (or Mini Maze) has continued to develop over the last several years. It is similar to the concomitant ablation, except that the surgeon reaches the heart through small incisions on each side of the chest and does not require that the heart be stopped. You may wish to discuss this procedure with your doctor if:
- You have AF symptoms that are severely interfering with your quality of life
- Your medications are not working or you cannot tolerate their side effects
- You are at risk for forming clots and having a stroke
For the Mini Maze, the surgeon accesses the heart by making three small incisions between the ribs, through which a tiny camera and videoguided instruments are inserted.
As in the open chest procedure, the surgeon uses an energy source to make precise scars, or ablations, on the heart to block the irregular electrical impulses that cause AF and removes or closes off the left atrial appendage where stroke-causing blood clots often form.
The Mini Maze procedure has proven to be an effective treatment offering many more patients the option of ablation therapy without having to undergo major concomitant surgery. Also, not having to open up the whole chest makes recovery much easier and reduces the average hospital stay to around four days.
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