These operations treat AF by interrupting the electrical impulses that cause the abnormal heart rhythm. These interruptions are caused in a variety of ways, including incisions in the atrial walls, heating of the heart tissue with radiofrequency probes, or freezing with cryothermy probes. Columbia surgeons have developed several atrial fibrillation ablation procedures, including minimally invasive and off-pump versions, totally closed-chest (robotic) ablation, and hybrid ablations, in which the procedure is made less invasive by combining surgical and catheter-based ablation techniques. The specific approach used is determined by each patient’s unique characteristics and anatomy, and these ablations can be performed for patients with “lone AF” or those having another cardiac operation, such as coronary bypass or valve surgery.
The MAZE Procedure
The MAZE Procedure is a surgical approach that treats atrial fibrillation by interrupting the electrical impulses that cause abnormal heart rhythm. The surgery typically involves the placement of incisions in both atria, however can be modified to suit a given patient's condition. When the incisions heal, scar tissue forms and prevents abnormal electrical impulses from passing through the heart. This technique is highly effective in curing atrial fibrillation. However, potential complications of the procedure include fluid retention and other risks associated with open heart surgery such as bleeding, infection, stroke, and pneumonia. For these reasons, and because the classical MAZE procedure requires a breastbone splitting incision, use of the heart-lung machine, and multiple incisions in the heart, this procedure has not been embraced by many patients and physicians.
Surgical Atrial Fibrillation Ablation (SAFA)
To reduce the risks and trauma associated with the classic MAZE operation, surgeons at Columbia University Medical Center Heart Institute have developed modification of the MAZE, known as Surgical Atrial Fibrillation Ablation (SAFA). In these procedures, a variety of energy sources such as radiofrequency, microwave, or laser, are used to create a limited number of scars in the left atrium, avoiding the need for many incisions in the heart. Furthermore, our surgeons have developed minimally invasive versions of SAFA, in which left atrial lesions can be made without opening the breastbone or using the heartlung machine.