Since its introduction in 1987, the Maze procedure has been regarded as the 'gold standardÔÇÖ for the surgical treatment of atrial fibrillation (AF). However, the complexity of the procedure has restricted its adoptability in the surgical community and provided an impetus for the development of less complex operations for the effective treatment of AF. As Dr James Cox has noted, the absolute number of patients who have been cured of AF with a simpler, modified Maze approach has dwarfed the number cured with the Maze III procedure.1 The modified procedure, which makes use of alternative forms of energy to replace the incisions made in the classic 'cut-and- sewÔÇÖ Maze, has opened up new avenues in the surgical treatment of AF. These new approaches include cryothermal applications, which have been referred to by practitioners as 'Cryo MazeÔÇÖ procedures.
Developing a Widely Applicabl e and Effective Surgical Treatment for AF
In the surgical treatment of AF, lesions are produced in the atria to isolate the trigger mechanism of the arrhythmia or to create a physical barrier to the re-entrant circuits of electrical signals that induce and maintain the arrhythmia. The Maze procedure is widely regarded as the most effective surgical treatment option for AF. While it has achieved success rates approaching 99%, the complexity of the 'cut and sewÔÇÖ Maze procedure has limited its adoption within the surgical community. As a result, fewer patients are cured of AF with the Maze III than with modified approaches utilizing various energy modalities to create electrical isolation. For a surgical procedure to be applicable to large numbers of patients, three crucial factors must be addressed: complexity, efficacy, and adoptability.1
- complexity - the more technically demanding the procedure, the higher the perceived risk, resulting in a lower adoption rate;
- efficacy - the success rate achieved by the procedure must be high enough to constitute a true benefit to patients; and
- adoptability - a gauge of surgeonsÔÇÖ willingness to perform the procedure based on its complexity and efficacy.
In addition to these criteria, safety must remain a prime consideration when selecting an energy source to create the required lesions in a partial or mini Maze approach. Empirical experience has shown that it is not necessary to create all of the lesions of the original surgical Maze III procedure. Evidence strongly suggests that neither the septal nor the left atrial appendage lesions are crucial to the ablation of AF.