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Wolf Mini-Maze Procedure for Atrial Fibrillation

Physicians from The University of Texas Health Science Center at Houston (UTHealth) Medical School and affiliated with Memorial Hermann provide a procedure for patients with lone atrial fibrillation (AFib). The Wolf Mini-Maze is minimally invasive surgical, beating-heart left-atrial isolation technique proven safe and effective. The procedure combines minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage.

The surgeon works through one 6-centimeter and two 1-centimeter incisions made between the ribs on either side of the chest, using a scope to view the heart directly and maneuver specially designed surgical instruments. These bilateral ports are positioned over the pulmonary veins on the right and over the left atrial appendage (LAA) on the left to allow direct 3-D visualization of the heart.

Using a special bipolar radiofrequency (RF) clamp, the surgeon ablates and isolates the pulmonary veins – the location of the AF triggers. The bipolar clamp enables the ablation to be performed in several seconds versus two to three minutes as required by the conventional unipolar RF.

The second part of the procedure involves the endoscopic excision of the left atrial appendage, the site of clot formation that can lead to stroke in patients with AF.

Benefits and outcomes

Preoperative workup includes a transthoracic echocardiogram within the past year, ECG and stress test if the patient’s history dictates it. Most patients undergo a 64-slice CT one to two days before the procedure to rule out significant coronary artery disease, pulmonary vein (PV) stenosis and thrombus in the LAA, and to evaluate the PV anatomy. Any history of obstructive coronary artery disease or valvular heart disease must be evaluated before surgery.

The AF-free rate following the procedure depends of the type of atrial fibrillation. Patients with paroxysmal AF have demonstrated a 92 percent AF-free rate from 1 to 6 years following surgery. Patients with persistent AF have shown an 85 percent AF-free rate from 1 to 6 years out. For patients with persistent AF lasting more than a year, the AF-free rate is 70 percent over the same time frame.

Strokes caused by atrial fibrillation are particularly devastating. The endoscopic exclusion of the left atrial appendage makes the Wolf Mini-Maze procedure efficacious for patients who are at high risk for stroke or have had previous strokes, or who do not tolerate anticoagulants.

In some patients who may not be candidates for the entire ablation technique, the left atrial appendage alone can be removed in a 45-minute procedure.

Patient selection and indications

To qualify for the Wolf Mini-Maze procedure, patients must have documented paroxysmal, persistent or long-standing persistent atrial fibrillation. Patients are not excluded based on age, low ejection fraction, obesity or previous pulmonary vein ablation procedures or open-heart surgery. Each procedure is specifically tailored to the patient.

Workup

Preoperative workup includes a transthoracic echocardiogram within the past year, ECG and stress test if the patient’s history dictates it. Most patients undergo a 64-slice CT one to two days before the procedure to rule out significant coronary artery disease, pulmonary vein (PV) stenosis and thrombus in the LAA, and to evaluate the PV anatomy. Any history of obstructive coronary artery disease or valvular heart disease must be evaluated before surgery.

Postoperative care

Checkups are performed at one week, 6 weeks and three, six and 12 months postoperatively and then annually. Various strategies are used for weaning patients off antiarrhythmic medications and anticoagulants after surgery. Patients are encouraged to participate in an integrative rehabilitation program, which includes diet, exercise and yoga. The program is open to all patients who are evaluated for the procedure.

About the Heart & Vascular Institute - Memorial City

Learn more about the Memorial Hermann Heart & Vascular Institute - Memorial City.

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To refer a patient to the Memorial Hermann Heart & Vascular Institute - Memorial City, please complete the form at the top of this page or call (713) CARDIAC.