Abstract
The Cox maze procedure developed originally in 1987 by Dr James Cox has evolved from a “cut and sew” surgical procedure, where the maze was applied using multiple surgical cuts, to an extensive use of surgical ablation technology where ablation lesions are placed with alternative energy sources (radiofrequency, cryothermy, microwave, and high-frequency ultrasound). Furthermore, the procedure has changed from a median sternotomy approach only to one that can be performed minimally invasively and robotically. The purpose of this paper is to review the current available technology for the ablation of atrial fibrillation as well as the different procedural approaches for the surgical ablation of atrial fibrillation.
Highlights
The maze III procedure has met with great success as reported by Washington University and has shown a significant reduction in cerebrovascular accidents and transient ischemic events due to the high success rate of ablating atrial fibrillation and amputating the left atrial appendage.[7,8,9,10]
The pericardium is secured to the chest wall for retraction, and umbilical tapes are placed around the superior vena cava (SVC) and inferior vena cava (IVC)
Bilateral pulmonary vein isolation (PVI), left atrial appendage (LAA), and ganglionic plexus (GP) ablation at 6 months was found to be more effective for paroxysmal atrial fibrillation (AF); 86.7% of patients with paroxysmal fibrillations were in normal sinus rhythm and 71.7% were both in normal sinus rhythm and off antiarrhythmic drugs (AADs).[28]
Summary
Surgical Technologies for Atrial Fibrillation circuit options in the atria After several modifications, this surgery is known today as the maze III procedure, and in its modern form most of the surgical incisions have been replaced by surgically placed linear lesion lines created by alternative energy sources (cryothermy, radiofrequency, and high-intensity focused ultrasound) and specially designed devices.[1,2,3,4,5,6]. The two current major strategies are a complete Cox maze III using minimally invasive approach and totally endoscopic left-sided surgical ablation approach
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