Revolutionizing Treatment for AF: The MicroMaze Procedure

Dudley Hudspeth, MD and Angela Szczublewski
Dudley Hudspeth, MD and Angela Szczublewski
How did the MicroMaze procedure come about? Who was the first to perform it? This procedure was designed to offer effective atrial ablation to more patients via a minimally invasive thoracoscopic approach. I am not sure who first performed a version of the operation. It has been done now for about 18 months. Describe how the MicroMaze surgery is performed. A right thoracoscopy is done and the pericardium is opened. The transverse and oblique sinuses are opened under direct vision and a flexible microwave catheter is used to encircle the heart. From left thoracoscopy, the left atrial appendage can be closed. How many patients has this been performed on so far? Probably 500-600 of these operations have been done so far. I have done about 20. What has been the success rate? Does this completely cure atrial fibrillation? The operation has proven to be very effective for intermittent/paroxysmal atrial fibrillation. Approximately 90-95% of these patients are staying in sinus rhythm at one year. The chronic/continuous patients have not done as well. I have concentrated on this operation for paroxysmal patients, who comprise about half of the lone atrial fibrillation group. Have there been any complications associated with this surgery? What is the recurrence rate, if any? There are potential complications with any surgery. Pulmonary vein stenosis and esophageal injury have not been reported to my knowledge. Cardiac and phrenic nerve injury are possible. Recurrence is unclear, as this procedure has been followed for a limited time. Recurrence for paroxysmal patients seems unlikely in the near term. We have no large series of reported patients yet, and long-term follow-up has not been done yet. Are there any patients who should not participate in this surgery? Seventy percent of patients with atrial fibrillation have structural cardiac disease and are not candidates. Those who have had other thoracic surgery are not candidates. Patients have to be able to tolerate general anesthesia. They cannot be morbidly obese. Patients must be monitored for close follow-up, and be willing to follow a medical regimen including coumadin. How does the MicroMaze procedure differ from other atrial fibrillation treatments available today, such as radiofrequency ablation? Describe some of the benefits that MicroMaze offers in comparison. The MicroMaze procedure offers an excellent chance to cure atrial fibrillation in selected patients. Because the lesion set offers a full thickness ablation in a very controlled manner, the current results indicate that the long-term results will be durable. The operation is minimally invasive. Patients are in the hospital for a few days on average, and resume their normal activities very quickly. Is this technology being offered at any other hospitals? There are a number of centers in the US offering this surgery. Our surgical group offers a complete range of available technology to treat all forms of atrial fibrillation through the MicroMaze to traditional open-heart MAZE procedures. What other treatments for atrial fibrillation do you offer at your hospital? We perform all currently available operations for the treatment of atrial fibrillation. We are in close communication with companies developing new technologies that may soon be clinically available. We are interested in the care of patients who need a variety of minimally invasive cardiac procedures.