A Hybrid Maze Procedure for Long-Standing Persistent Atrial Fibrillation

James L. Cox, Andrei Churyla, S. Chris Malaisrie, Duc Thinh Pham, Jane Kruse, Olga N. Kislitsina, Patrick M. McCarthy

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


Background: Catheter ablation (CA) for long-standing persistent atrial fibrillation (LSPAF) is suboptimal, and open surgical ablation, although more successful, is too invasive to be a first-line therapy. Less invasive hybrid procedures that combine thoracoscopic surgery (TS) with CA have been only marginally more successful for LSPAF than CA alone. Methods: Joint hybrid procedures for LSPAF are based on the assumption that AF surgery and CA procedures can be guided by intraoperative mapping. However, intraoperative mapping is not always dependable because of the transient nature of the sustaining reentrant drivers. The best results in patients with LSPAF have been attained with the non-guided, anatomy-based surgical Maze-III and Maze-IV procedures. Likewise, a staged TS/CA hybrid procedure that creates a combination of lesions that adhere to the concept of a Maze pattern, that is, a Hybrid Maze-IV procedure, should be more effective for LSPAF. Results: Initial TS includes all lesions of the Maze-IV procedure except the mitral line, coronary sinus lesion, and one right atrial lesion. Follow-up CA at 3 months includes touching up any incomplete TS lesions, a cavotricuspid isthmus lesion, and a mitral line/coronary sinus lesion in the 10% to 15% of patients with post-TS perimitral flutter. This combination of TS and CA lesions creates a complete Maze-IV procedure. Conclusions: It is possible to create the complete lesion pattern of a Maze-IV procedure with a staged TS/CA hybrid procedure. The success of this Hybrid Maze procedure in patients with LSPAF should be the same as that attained with an open surgical Maze-IV procedure.

Original languageEnglish
Pages (from-to)610-618
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number2
StatePublished - Feb 2019


Dive into the research topics of 'A Hybrid Maze Procedure for Long-Standing Persistent Atrial Fibrillation'. Together they form a unique fingerprint.

Cite this