1 AnswerUCLA Health answeredThe lariat procedure is used to treat people with atrial fibrillation. In the lariat procedure, a needle is used to enter the sac surrounding the heart and guide a loop of suture around the base of the left atrial appendage to permanently seal off the part of the heart where blood clots form to cause strokes in people with AF. An advantage of this approach is that doctors don’t leave hardware within the heart, which is important for people who can’t take blood thinners.
1 AnswerUCLA Health answeredIn the past, doctors had only medication choices to prevent stroke in people with atrial fibrillation (AF). Now, however, several options are available. Minimally invasive procedures can wall off the left atrial appendage, the part of the heart where blood clots form to cause strokes in people with AF. Several ongoing clinical trials may provide still more options for AF treatment.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Henrico Doctors' Hospital - HCA VirginiaPeople who have had the hybrid maze procedure for atrial fibrillation (AFib) are evaluated after the procedure at six- and 12-month follow-up intervals, and seen on an as-needed basis thereafter. Because the hybrid maze procedure is performed in a single setting and can fit within the normal practice requirements of catheter ablation, it avoids the downfalls of complex surgical procedures, including the pain associated with large chest incisions or ports. This demonstrates the ability to treat persistent and longstanding atrial fibrillation with minimally-invasive techniques, better outcomes and reduction of long-term recurrence.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Chippenham Hospital - HCA VirginiaDuring the hybrid maze procedure for atrial fibrillation (AFib), after anesthesia, the surgical team first performs the epicardial ablation portion of the procedure, creating the lesions around the heart. This is performed through an endoscopic incision in the diaphragm using a radiofrequency technique, allowing the heart to continue its normal function throughout the operation. The opening in the diaphragm is sized specifically to facilitate the passage of the epicardial ablation device and an endoscope, allowing the surgeon to visualize both the atrial surface and the space around the heart during the procedure.
Upon completion of the epicardial ablation, a drain remains in place around the heart and the abdominal access site is closed. At this point, the electrophysiology team takes over the procedure to perform the endocardial ablation, creating any necessary lesions on the interior walls of the heart, using irrigated tip catheters to access the multiple sites. After the operation, the pericardial drain is left in place for 36-48 hours; the patient is observed for a further 24 hours post-drain removal.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Johnston-Willis Hospital - HCA VirginiaThe hybrid maze procedure aims to help manage atrial fibrillation (AFib) without relying on repeat treatments. The endoscopic approach allows epicardial access and ablation to be accomplished without violating the chest or deflating the lungs. It also enables a single-setting procedure to be performed in the electrophysiology laboratory, potentially reducing post-procedure pain, decreasing length of hospital stay and improving recovery.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Henrico Doctors' Hospital - HCA VirginiaThe hybrid maze procedure helps manage atrial fibrillation (AFib) without relying on repeat treatments such as radiofrequency ablation therapy, cardioversions (ongoing electrical manipulation of heart rate) or continued adjustment of medications. The hybrid maze, so named for the maze-like set of incisions made on the left and right atria, is a multidisciplinary, closed-chest, minimally-invasive endoscopic procedure that creates scar lines (lesions) on the epicardium (the outside of the heart) without compromising the pericardium (the membrane sac enclosing the heart and other major surrounding vessels). The lesions work to divert the abnormal electrical impulses in the heart that cause the arrhythmia, isolating them and allowing the heart to return to its normal cadence.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Chippenham Hospital - HCA VirginiaNot only is atrial fibrillation (AFib) of serious concern for affected people, but it is also a burden to the healthcare system, needing long-term treatment and management to address its rapidly increasing prevalence. AFib care costs nearly $15,000 annually in incremental direct and indirect costs per person. To reduce healthcare costs and hospitalization rates and improve quality of life, innovative treatments such as the hybrid maze procedure aim to manage AFib without relying on repeat treatments such as radiofrequency ablation therapy, cardioversions (ongoing electrical manipulation of heart rate) or continued adjustment of medications.
1 AnswerPenn Medicine answered
When medications do not work in the treatment of atrial fibrillation (AFib), there are alternatives:
- Electrical cardioversion. This is a controlled procedure and is conducted under light anesthesia in the hospital, and you usually go home the day of the procedure.
- Catheter ablation
- The Maze procedure. This often requires open heart surgery because the clinician must make precise, small cuts (or possibly catheter burns) in specific places on the atria. The procedure’s name comes from the mazelike pattern of incisions made in the atria. Usually, the Maze procedure is performed only when open heart surgery is required for other reasons.
If you suspect you have atrial fibrillation (AFib), set up an appointment with your doctor. A doctor will usually start by looking at your personal medical history as well as your family history. The information from you will help your doctor understand your specific symptoms and how severe they may be, as well as define your AFib clinically. The discussion should also reveal your AFib frequency, duration, precipitating factors and how it terminated (if it did).
If you received any treatment for AFib before seeing your doctor (for example, if paramedics administered a drug or defibrillation therapy), your doctor will want to review your response to such therapy.
There are a number of temporary (acute) that can cause atrial fibrillation (AFib). For the most part, when the temporary condition ceases or is treated, AFib usually is resolved. The acute conditions are:
- Lung disease, such as pneumonia
- Asthma attacks
- Extreme body stress
- The occurrence of a metabolic disorder, such as hyperthyroidism (overactive thyroid gland)
- An inflammation of the lining of the heart
- A heart attack, which also increases the risk of AFib
Many of the acute conditions listed can cause chemical imbalances that may lead to electrical imbalances in your heart, triggering AFib. However, once the necessary balance is restored, the AFib may disappear on its own.