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Cardiac Ablation , Electrical Cardioversion, Mini-Maze
I am confused with the 3 different procedures (Cardiac Ablation, Electrical Cardioversion, Mini-Maze) used to try to get rid of Paroxysmal A-fib. I have tried to understand the 3 but I don't quite get it. I think that a procedure called Maze is done when you need open heart surgery for other reasons but a mini-maze is done for Paroxysmal a-fib. I don't need open heart surgery so I wouldn't need the Maze. I would like to know a detailed explanation of each procedure and why are they different and which one is the best. Perhaps someone can direct me to this information so that I clearly understand what is in store for me and help me to make the right decision and also how to choose a doctor to perform the procedures. I live in Oklahoma and not sure of the choice of Electrophysiologists that they have here to perform these procedures.
Any information would be appreciated.
MellanieSAF, October 13, 2019 12:22pm EST
1. Electrical cardioversion is shocking the heart back into normal rhythm, like rebooting a computer. This is the simplest procedure.
2. Catheter ablation is done by an electrophysiologist on the inside of the heart by accessing it through the groin (or sometimes arm or neck). This requires 1-2 days in the hospital.
3. Mini maze is done by a cardiac surgeon on the outside of the heart by accessing it through the underarm area or through the ribs. The left atrial appendage is generally closed with an AtriClip or similar device. This requires 2-4 days in the hospital.
Get more details on each by clicking on the links above. The catheter ablation and mini maze sections link to StopAfib.org for more details, or go there directly by clicking here: Can Afib Be Cured?
You may also hear of mini maze being called TTM (totally-thoracoscopic maze) or VATS. Another version is the convergent procedure, with access through the diaphragm rather than under the arms. There is also the hybrid procedure combining mini maze and catheter ablation, which is currently in a clinical trial (DEEP Trial).
You can learn more by watching the afib patient conference where we spend an entire day on catheter ablation and surgery and how to choose the right procedure for you. You may want to watch the:
- Livestream replays from the 2019 conference (nominal charge to defray the cost): https://getinrhythm.com/
- Livestream replays from the 2018 conference (free, thanks to a sponsor): https://getinrhythm.com/2018-livestream-registration/
Torilyn50, October 13, 2019 2:34pm EST
Thank you for your reply. So am I correct in saying that the decision on which procedure to have is up to the patient? An electrophysiologist will probably tell you to have an ablation and a cardiac surgeon will suggest a mini-maze. How do you make the right decision? And what are the things you look for in an excellent electrophysiologist to do an ablation and a Cardiac Surgeon to do the Mini-Maze? It does look like if you don't have an experienced Doctor, it could turn out not so good....
macaodha, October 14, 2019 5:42am EST
Thank you for taking the time to explain, it's the most detailed explanation of these procedures I've ever read or heard! I haven't posted lately (but I do read all the posts) because after my 2nd Ablation at The Cleveland Clinic (Ohio Campus), I've been in NSR. It's a great feeling, I'm back to exercising & walking, and started the Anti-Inflamation Diet (much like the Mediterranean Diet) to lose more weight & clear out the inflammation in my body.
How is your husband? I continue my prayers for him and for you. Thank you for ALL you do for us 'Fibbers, you're a doll!
MellanieSAF, October 14, 2019 9:51am EST
Good to hear that you are doing so well.
Thanks for asking about my husband. He is doing much better, though post-heart attack heart failure is an ever-present challenge that you have to focus on every day. I've learned far more about heart failure than I would have ever expected. Fortunately, I have access to some of the world's experts in this space.
Thanks so much for your kind words, too.
MellanieSAF, October 14, 2019 9:59am EST
Yes, the decision is up to the patient, though your insurance may decide to reject one procedure or the other and the doctor may have to intervene to get pre-approval.
You're right - EPs say to have catheter ablation and surgeons say to have surgery. And, you need to find someone with a lot of experience. For ablation, they should do at least 50-100 AFIB ablations per year (not just easy ablations, but afib ablations). For surgeons, probably 25+ mini mazes per year is a good number.
Generally, if you're in the first 2-3 years of afib and are paroxysmal, a catheter ablation will work. For longer-term afib, especially if it has gone persistent or longstanding persistent, ablation can be difficult and several may be required, so some EPs may refer those patients to a surgeon for mini maze.
In my case, I'd had paroxysmal afib for 22 months when I had my procedure. It was in the early days of catheter ablation when results were not as good as they are today, so I skipped catheter ablation and went straight to mini maze. For me, getting rid of my stroke risk through handling the left atrial appendage was a big part of that decision, too. (Here's my story: https://www.stopafib.org/mellanie.cfm).
It's not easy to choose the right procedure, which is why we have the "How to Choose the Right Procedure" panel during the patient conference. Please take the time to watch at least day 2 of the conference. The answers are all there.
Torilyn50, October 14, 2019 2:53pm EST
Thank you Mellanie. You have been very informative and I really appreciate it....
Torilyn50, October 14, 2019 5:04pm EST
Hi Again Mellanie:
I just called an Electrophsyiologist here OKC. I went in to see him 2 yrs or so ago when I was diagnosed with Afib to discuss Ablation. Anyway, his office just told me he has performed 1000 Catheter Ablations for Afib in a year. That's like 20 in a week! Is that even possible? I did repeat "1000 Catheter Ablations for Afib in a year" and she said "yes" every time. Time to find a new Electrophsyiologist or just don't ask office staff that question....?
MellanieSAF, October 14, 2019 6:49pm EST
I don't know that even Dr. Natale does 1,000 AFIB ablations in a year.
Oklahoma City has some good EPs; maybe Dr. Sonny Jackman, who is one of the pioneers of ablation and is in OKC, has at one time done 1,000 in a year working 14-16 hour days, but I don't think that Dr. Jackman has done ablations in a number of years (I may be wrong - I never think to ask when we talk). He mostly trains the newer guys there, like Dr. Stavrakis.
Generally, afib ablations take 3-4 hours each. Let's say that an EP has teams that set up the patients for ablations and he or she spends about 2 hours on each ablation. That would be eight solid hours in a day right there, and 250 days a year to do 1,000 afib ablations. When would he or she see patients? That means no time off for speaking and attending medical conferences or doing research. That means no other kinds of ablations, and no other procedures either.
Perhaps the staff person misspoke or misunderstood.
Jeanamo815, October 14, 2019 7:08pm EST
Torilyn50, 1,000 ablations a year does sound like a bit "much". I cannot imagine an EP who could manage so many..... an ablation can take a number of hours....and the EP must have at least one day for clinic to see patients. I suspect the staff member who quoted the !,000 was just choosing a big number to let you know that the doctor has done a lot of ablations. Or...perhaps there are several doctors in the same practice and the staff member was quoting the number for all of them.
I also have paroxysmal a-fib...or at least did...before my ablations. It took three for me to stay in normal sinus rhythm. My last one was in Sept. of 2014 and I have been in normal sinus rhythm since then. I do still take Eliquis as a safequard against stoke if the a-fib returns (which is possible). I do not regret having the ablations and had no problems with the procedure or with the recovery. If your EP has a lot of experience...and you would be in a hoptial with a lot of experience with the procedure, then i believe you might want to consider ablation if your EP recommends it.
After considering all the options, I hope you will find the solution with which you will feel be most comfortable. Meallanie is our expert on all things a-fib, so be sure to visit websites that she recommends for information.
Wishing you the best,
(My A-Fib Experience Community Leader)
SugarIsIt, October 15, 2019 11:22pm EST
You might want to try this before any surgery:After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer. If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt??
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at: Cardiab.biomedcentral.com/articles/10.1186/1475-2840-7-28