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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery

VCU Division of Cardiothoracic Surgery

Atrial Fibrillation Program

Surgical Treatments for AF

Successfully managing atrial fibrillation can be difficult, which may lead to consideration of options for trying to cure the condition. The term ablation will be used frequently and means destruction of abnormal tissue. Using ablation, abnormal electrical signals can be blocked.

Surgical ablation procedures offer an excellent chance of curing atrial fibrillation. The success of each approach varies, and the type of AF a patient has can play a role in the options that are available. Surgical procedures also carry risk, which must be discussed with the doctor. Physicians at VCUHS perform over 100 surgical ablations per year for atrial fibrillation.


Open-chest Surgical Ablation

Many patients are treated with an open-chest operation called a Maze procedure. It has been highly effective for a wide range of atrial fibrillation patients. It can be a cure, but is highly invasive, requiring open-heart surgery and heart lung bypass.

The surgeon uses instruments to identify the faulty electrical sites in the heart that are causing it to beat irregularly and too fast. Then an instrument with a source to heat or freeze tissue is used to create precise ablation lesions. This can return the heart to a normal rhythm.

Some patients with AF who need open-heart surgery for another reason, such as bypass surgery or valve replacement or repair, have their surgeons perform this procedure too. It takes only another 15 to 25 minutes to create the necessary scars that can block the abnormal electrical impulses. Many surgeons will also remove or close off a small out-pouching of the heart (the left atrial appendage) that is believed to be the main site where stroke- causing blood clots form during atrial fibrillation.

Minimally Invasive Surgical Ablation

Doctors have developed a minimally invasive approach often called the "mini-Maze." It is similar to the open-chest ablation except that he surgeon gains access to the heart through three small incisions on each side of the chest. Through these small incisions endoscopic cameras and instruments are passed into the chest. A heart lung machine is not required. This approach usually takes about four hours and, as in open-chest procedures, the surgeon uses an energy source to make precise scars on the heart to block the irregular electrical impulses that cause AF.

Again, many surgeons will close off or remove the small flap on the heart that is believed to be the main site of stroke-causing blood clots. Because the chest does not have to be opened, recovery is much easier and the average hospital stay is around four days.





or visit the Atrial Fibrillation Program Website