Following yesterday's interesting posts about the Wolf maze I decided to find out more about this procedure and so I emailed Dr Wolf and asked him to point me in the direction of any clinical studies on the efficacy of his procedure.
He didn't send me that but he did send me a photo of a report which I was then able to duly track down on PubMed.
The report which I will attach was a meta-analysis (ie it brought together results of many other clinical studies). The authors stated that it had limitations of homogenity (ie not a broad mix of sex, race etc) and possible publication bias (this is where studies which show poor results are not published, usually).
The meta analysis gave a two year success rate (meaning no episodes and no drugs) as follows:
81% paroxysmal Afib
63% persistant Afib
67% long standing persistent Afib.
The average age of all the studies was 59 but with a spread of +/- 10 years. Oldest was 79, youngest 37.
No info was given as to whether the patients had previously had any other type of catheter ablation.
So this was all Dr Wolf sent me and, obviously, it does not refer to his self-named procedure only (or even at all). From that, I assu e there are no clinical studies showing his results or he would have been eager to share them. This is not to imply it does not work, obviously from yesterday's testimonies it does, but just to say there is no independent peer reviewed stuff out there.
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Jajarunner
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Well done, interesting information. Not sure I would risk it with those stats but I guess it depend how much you want to chase NSR, if it’s economically viable for you.
It’s a shame there is no medical audit and the reliance on testimonials, glowing though they may be is really not enough.
Still digging abd it turns out he's been banned from the British Medical Journal in the past for not making full disclosures about financial interests!Oh, and he's a magician in his spare time! Nor relevant but made me chuckle!!
I'm not playing poker with him in that case ! Serious though anyone can post anything on the internet - be careful about what you read and double check everything.
It seems if the Wolf procedure was accepted by medical professionals it would be widely recommended and performed by others. As for myself, I will continue with this arrogant cardiologist I have. But I have full trust in the young man.
🙂🙂🙂
Is there compensation for testimonials, many overexuberant ? Draw your own conclusions.
How sad. Those that do not understand would rather put down others. Perhaps you should talk with the 3000+ people that have had a Wolf Mini Maze.And by the way. Publishing takes time and it is "bought"
Screw pier reviews, I dont trust the medical community as it is, I will trust what other unpaid patients have experienced,
Amen Bambi! I don’t trust the medical community either, especially since I’ve seen the fraud and lies fromThem that have accompanied Covid. Peer reviewed reports alone would not convince me of the WMM.
IF... Dr. Wolf was to come to the UK to provided a few patients with this procedure, who would be willing to get in line? Got questions about this??? well spit them out.
I would happily get in line. In fact I would be at the front of the queue. If I had the money to book myself into having this operation either in Japan or the uk or with Dr Wolf I would do it tomorrow. I have persistent AF I have a deep passion for surfing which has currently been taken away from me. I’m an out door person and a runner. I’ve spent two months researching everything I can find, including patient experiences. Some might think I’m mad as I tolerate my AF very well it’s persistent but not extreme. But the beta blockers and anticoagulants are diminishing my quality of life and negatively impact my mental health. As someone who suffers anxiety my recent diagnosis and medication has been horrendous. So yeah I’d get in line happily.
I can assure you there’s no compensation. My feeling about why more cardiac surgeons don’t do this is because they are interested in much more serious heart conditions. Afib is considered not that serious. Since it can’t be done by an electrophysiologist, a cardiac surgeon has to do it. The Methodist hospital is the largest in the world. The Debakey team is well know and respected worldwide.
To add to your thoughts, as Dr Wolf said most cardiac surgeons are used to working on a non beating heart in an open chest. Most are not interested in learning how to work on a beating heart with just a camera to guide them. As you stated Dr Wolf said it is simple to do but not easy.
Yes, I also could not find any peer reviewed studies, and being that my SIL is veteran cardio NP at the cardio unit at a major hospital, I bounced it off her.Her response was not so much skepticism, but a kind of “oh ya old news” sort of dismissal. When I further questioned why such a tepid response, her reply was...”this is our life here in the cardio unit...it’s all we live, breathe and eat, all day everyday, so no, nothing *slips by* us when it comes to new innovations, techniques, training, equipment and doctrine. Globally, we are a very specialized and close-knit community, so we tend to stay on top of new developments.”
I think Dr Wolf just does a mini maze. It's a respected procedure, but he claims HIS version is somehow better. No scientific proof of that latter claim. Very interesting of the reaction in the cardiac field ....
I understood Dr Wolfs mini maze USP was the fact he could perform a maze procedure through a small hole in the chest, rather than a full open up the chest cavity, major operation. IF am barking up the right tree , there are videos online where you can watch the operation. I thought I had seen these via this forum?
Totally Thoracic cardiac procedures and Hybrid ablations are performed through keyholes to pass the camera and ablation instruments. youtube.com/watch?v=KxwYHpz...
The Mini Maze keyholes are 30mm or so in size on the sides of the chest between the ribs, whereas others do it near the abdomen.
The procedure is done through a minimum of 3 incisions on each side. Two smaller ones and one about 3 inches long. Though termed minimally invasive as compared to open heart surgery it is not truly a minimally invasive procedure. It can be a tough recovery for some. But just about every patient will tell you it is worth it.
Dr. Wolf, during a pre op exam, found a very serious heart defect that the patient's cardiologist should have pick up several years ago, which was probably the cause of the afib!.Another specialist at Debakey Heart Center did the repair on the defect which had to be open chest surgery. The Dr. Wolf did the HIS procedure to ensure no afib or stroke by clamping the LAA.
This info HAS been edited to correct a mistake I made., Thanks theohappy.
Just to clarify Dr Wolf did not do the corrective part to the heart defect. Another cardiac surgeon did that. He only did his WMM part. He stated that in the WMM FB site.
Yes you are correct!!!! Sandi had said that another specialist fixed the heart problem. My mistake. He was very lucky that to have both docs there!!! Im just shocked that his own cardiologist back home did not find the problem before, since it was there for a while.
I will correct the info above, thanks for letting me know, much appreciated.
I dont believe he is doing a full "maze" . but I will check in to be sure. Want to keep factual in all things, and even I misunderstood as you will see below.
Oh I was aware of how the procedure was done as compared to standard maze, but the question was, more of how different was it to other mini maze procedures done elsewhere, and I was getting the impression, that somehow Dr. Wolfs' procedure that carries his name, was radically different, a pioneering breakthrough if you will ...but I could find no literature stating that assumption, so I was merely looking for answers. I am not, at this juncture, a candidate for the procedure, but If I were to become on in the future, I'd like to know why I should spend well into the 6 figures for a procedure in different country when it is available here.
The difference between the wolf mini maze and other mini mazes is that some do not clamp the LAA and some do not ablate the ganglionic plexi. If you watch the video posted here you will hear Dr Wolf explain why he does those two things and why it has brought better results.
That's so useful to know. Peer review does set the bar doesn't it? It's a shame, because if he IS doing great work then it should be scrutinised and more people get t9 benefit. Does the meta abyss describe the type of patient who is considered suitable e.g. lone AF, certain comorbidities excluded etc ? These would be factors for health care services to consider.
Not necessarily. The Mehta study on the "uselessness" of Hydroxychloroquine was peer reviewed and published in the Lancet. It turns out that the data were completely spurious , provided by a company called Surgisphere. The directors of this company were a dodgy doctor who was already in trouble in America for marketing a phony device and a science fiction writer cum escort. The Lancet also published Andrew Wakefield 's discredited study and took 12 years to retract it.
Jajarunner. seeing that you are a stickler for facts, you should stick to the facts, as per your link:
The BMJ did not ban Dr Wolf.
It was the Journal of Thoracic and Cardiovascular Surgery, and the BMJ merely reported it.
"will be barred from publishing in the journal for one to two years, depending on the seriousness of the failure."
You did not mention that Dr Wolf may have been banned for not highlighting his connection to AtriCure when discussing a tool that he uses during his surgery.
Would it perhaps have helped to know that the specific tool is used as a matter of procedure in thousands of hospitals and is trusted by surgeons worldwide?
Would it have helped to know that Dr Wolf is the inventor of the tool and holds the patent jointly with AtriCure?
AMEN. And that is why I, for one, do not trust the science at face value. If all I had was a peer reviewed study on the mini maze to go on, I would not be having it done in June.
Just read this thank you for raising it. I am wondering, when I had ablation around 17 & 13 years ago I recall a phrase used called ‘mapping’ - just wonder if it’s the same but new title? 🤷♀️
I think mapping is just a image showing the interior of the heart, but don't quote me! Mimimaze is where they ablate the outside of the heart through the ribs, as I understand it.
No - Mapping refers to the an imaging system which literally maps out the blood vessels in your body so that an EP can thread a catheter safely to the area that requires attention.
The procedure under discussion is a mini maze which is a surgical operation performed with instruments inserted through the chest wall through a tiny hole, similar to a laparoscopic.
This is nothing like a catheter ablation for AF or AFl. Hope that explains. Best wishes.
I had a 3" scar and 2 smaller ones on each side 9 months ago from this. Today, while in my bathing suit, I cant even see them any more. Thats right 9 months and I have to really look for them
Wow, how did you find out that he is "very money driven" ?
All medical procedures in the US are some ten times more expensive than even private procedures in the UK.
To implant a Linq device to monitor AFib for five years costs $20,000 in the US and around £2,500 in the UK.
Dr Wolf is not a sole practitioner. He is employed by the Debakey cardiac centre in Houston Texas, a major hospital with many thousands of procedures every year, and the majority of the fee is to the hospital.
The procedures in the US are paid for by their Medicare insurance companies.
Would they do that if it were not efficacious and long-term ?
Dr Wolf performs 2-3 WMM procedures a week and has carried out over 2,500 since 17 years ago; his first patient is still in NSR after 17 years !
He is also the inventor of a cardiac device that is marketed by AtriCure (one of the most used instruments in thoracic cardiac surgery throughout the world).
To be fair always, best not to jump to conclusions- IMHO.
No, because it is not scientific. That's the whole point. I'm not saying it doesn't work, merely that there are no scientific studies to show it does. It obviously worked for those 3000+ people, nobody is disputing that, but it's not the point.Stay welll and glad you had a positive result.
It is scientific. Medicine is about science, and those that think out of the box are not welcomed with open arms all the time. Many are skeptical, and that includes my husband, another very skilled surgeon. He too was very skeptical of Dr. Wolf for a long time.So I understand your point somewhat, but keep in mind there are 3000 of us here, and I believe Dr. Toshiya Ohtsuka in Japan has done about 2000 WMM (which he calls a WO Mini Maze.
He does continuing education for the Debakey group monthly. This is the group that did the first heart transplant. There’s also a Facebook group run by a nurse who had the procedure four years ago. Lots of patient stories, etc. Dr. Wolf may not be interested in spending the time to obtain clinical valuation but would prefer to do surgery. Only a cardiac surgeon can do this procedure. There are a number of surgeons who do mini maze’s. I imagine they all have their own way of doing them.
I wonder if you know what’s involved in doing that. It’s a full time job. I worked at a teaching hospital and there were two different types of doctors. Those that published and those who were more interested in treating patients. I’m sure all of the information is available if someone wants to spend the hours correlating it, etc. maybe Dr wolf will do it when he retires. I kind of doubt it though. What would be the point. He’s training a replacement.
I am the nurse you are referring too who had the WMM after three failed ablations. I still wake up and thank God everyday I found Dr Wolf and his procedure. I did my homework prior to my decision but it wasn’t clinical studies it was studying his procedure and talking with countless others who were afib free for years after having his procedure . His very first patient from 18 years ago remains afib free. You can read on our Facebook site all of the success stories and some struggles through recovery that we all went through. He truly cares about his patients before, during and after the procedure. I feel very blessed to be one of the over 2500 WMM patients.
Well, it take lots and lots of time, and money to publish, just to get your name out there. As for peer reviews... Dr. Wolf has been invited as both guest and keynote speaker some of the most prestigious international heart conferences for many years. So cardiac surgeons, and thoracic surgeons that continue their education they will know him and his work. One other thing.... why are there not more of these surgeons that do this/??? Here is a link to what it looks like through that little hole with a camera. And yes, that is a beating heart and Dr. Okshi is clipping the LAA
Thank you for this!!!! Those that want to know are open to new information.
Those that look for faults will dig deep to find them and use them to put down what they dont want to understand.
Dr. Randy Wolf is a caring, very skilled surgeon that has repeatedly tried to train other surgeons from all over the world on how to end afib. They drop out half way through because it requires very skilled hands and skills that are earned through many years of practice.
I too am grateful for him, and the fact that he does magic is a bonus. That indicates he has a life outside of work.
Hi Bambi. I will not be thwarted by less-than-informed comments.
I am 75 and will travel to Japan to have the WMM - as performed by cardiac surgeon Dr Ohtsuka- where I can have it done, should my medications not cope.
"That's life (That's life), I tell ya, I can't deny it
Good for you.... Randy sais that if he needed this done, the only person he would trust was Oshi. They are very good friends from what I gather. Oshi is soft spoke, kind, and very attentive from what I gather from talking with him.If you do travel to him or even considering it, contact him on FB. He post everything.
Thank you Saul for posting this video. After reading this post I came here to post it after you put it up on the Facebook page. It tells a lot and DrWolf talks about the studies they have e done I. Spain, Netherlands etc. I’m not sure what definition is being sought as “scientifically proven” but I don’t need anything other than results to convince me. 🤷♀️
I did ask him for his studies, but he only sent me the title of the report mentioned in my original post unfortunately. As stated, this was a general meta analysis of the mini- maze procedure and nothing to do with his self named version of the mini maze although some of his results may have formed part of one of the studies included in the meta-analysis, i could not see that level of detail. I could not find any of the studies you mention on the internet, perhaps you could share the links on here for us to take a look at?
My best recommendation also are the dozens and dozens of real ex-patients of Dr Wolf on the FB group "Wolf Mini Maze - Live AFib Free".
The WMM is wildly successful and sought after and Dr Wolf is booked till September.
The above forum is free and open to all who have concerns about having AFib.
Patients post the good the bad and the ugly.
Some have longer healing (up to six months) after the procedure and freely complain, and others, like Bambi, already ski and windsurf after a few weeks.
I have not seen one post that someone regretted having the WMM.
The contrary is the norm with gushing praise and gratitude being the hallmark.
My earlier posts on this forum included two videos:
One is a conversation with a 92 year old patient on whom Dr Wolf operated the WMM in 2004 and is still in NSR (after 17 years when the video was produced last year) and no anti-coagulants after the WMM.
The other is Dr Wolf from 2012 discussing with the founder of the StopAfib web site how the WMM came about after experimenting for two years to come up with the minimally invasive WMM procedure.
To us all who suffer with AFib. Good healing and peace in our lives.
I hadn’t seen the 2012 one Saul. Thank you for posting it! The glowing praise and encouragement from dozens and dozens of people having had the WMM have made all the difference for me and I am very calm about having it in 58 days. Whoop whoop!!!!
Bravo to you and to Dr Wolf. I wish you continued NSR and full activity without limits.
Some folks assume that because only Dr Wolf in Houston and Dr Ohtsuka in Japan implement the WMM, it is suspect and they jump to wrong conclusions.
This, despite the fact that Dr Wolf's co-invention started AtriCure, a $2.8 billion company, and the bipolar clamp is now the most used surgical instrument for AFib surgery. All the best. Saul.
Hi Saulger. You are quite correct - I have been in touch with CD though messaging and it's all done and dusted. In fact I'll just remove my comment - no offence was intended.
Thank you Paul. I was not having a go, merely explaining how I read it.I wanted to mention that I am on this forum every day and yours (...and CD) are the first comments that I read. Always appreciate your cros-references and links.
The old adage is as true in medicine as anywhere else.. if something appears too good to be true it probably is...Don't forget that healthcare systems around the world (apart from the NHS , whatever it's faults) are commercial entities, designed to make money for the operators with successful patient outcomes simply being a by product... Rebranding essentially standard procedures, with a bit of selective marketing, is not untypical..
There are more up to date research studies on the hybrid procedures which I shared in my post on ‘videos for persistent afib’. The 3 EPs (U.K., Dutch and Italian) who speak all share study details.
The hybrid is the mini maze described here with a follow up catheter ablation if required to do the bits that can’t be reached from the outside of the heart. This increases the success rate to around 85% for persistent afib. Catheter ablations alone for this group of patients achieve 30-50% success depending on the study.
Dr Wolf’s procedure is a little different from the ‘mini maze’ in that he does not believe it is necessary to ablate the back of the heart, instead he tests and ablates the ganglionic plexi as he believes that afib is a nerve issue. This also has the advantage of leaving less scarring. He does have great success, if you join the Facebook group he has 4 patients a week currently going under surgery and more often than not they are part of the group and share their journey.
IMO surgery (mini maze) is not a route for all but much more effective for the later stages of afib than the alternative treatment options.
Very interesting. I do not doubt the efficacy of the mini maze, was just saying there is no independent verification of Dr Wolf's own technique. Thus does not mean it does not work oy that there are no scientific studies.
Hi Mav, you will see them on my posts. It was only a couple of days ago I shared a U.K. EP training conference focussed on hybrid as being a treatment for persistent (especially long term persistent) afib’.
This thread is a follow up on Bambi’s thread of a few days ago.
The comments are discussing the lack of scientific peer reviewed studies and ethical issues regarding none disclosure of financial interest when submitting article for the BMJ which resulted in Dr Wolf being banned from submitting further articles - and this would be a major publication for peer review.
Bambi has been more than generous with her reviews and experiences but that wasn’t the focus of this discussion. Bambi is undoubtedly biased but the questions arose from if it’s so successful, how come so few surgeons want to learn it and the thread gives us pointers as to the possible whys - economics and profits, lack of interest from Cardio thoracic surgeons in diversifying, resistance of EPs who don’t have the skill sets and dubious ethical non disclosure which tends to discredit a doctor from having future studies published for peer review resulting in a vote of lack of confidence. Now many doctors and researchers go through this reluctance to accept new methods as the process of proof of effectiveness is extremely rigorous as ethical standards are (and should be) very high. And it’s not foolproof.
That’s my summary of how I read the information above - endorsements from individuals are not enough. The Gold Standard of whether it is an effective treatment is Peer Review.
I’ve spent at least two months now following the WMM FB page. I’ve also asked a number of questions during the monthly online live video presentations DR Wolf does. I’ve also watched almost all past video presentations. And I have asked my EP’s opinion of the WMM who was not negative about it, but considered it to be a fairly invasive procedure. All to say, though I’m impressed with Dr Wolf as are his many patients, I too, have tried to pursue more statistical data related to the procedure. Most of the questions I’ve asked relate to that. Patients often quote a 95% success rate. But if you listen to his most recent video presentation, he openly shares that high success rate relates to those with PAF of less than I believe 5 years. Not sure about the time length. He goes on to present the other varying success rates based upon persistent AFib and persistent AFib of longer than, I believe (?), 10 years. Worth listening to. I think his patients are pretty honest about their journey. Some go through a pretty tough recovery. For me I’ve concluded the procedure is too invasive and recovery too tough for where I’m at physically. Otherwise I would likely get on the waiting list.
Economics and profits. Too many Drs in the USA have become profit driven. More money in doing multiple ablations rather than just one mini maze. Plus the ordeal of dealing with all the different medical insurances we have here and what insurance plans people can and cannot afford. Not all insurance plans will pay for this mini maze procedure. Some people have a lack of understanding that not everyone can afford the better insurance that would pay for it. So those people can't get it. And a lot of Drs don't like Medicare. Different insurance plans don't pay the same amount of money to the Drs and hospitals. Drs have to accept whatever amount the Medicare plan pays them. And sometimes the Drs don't think it's enough. There are Drs who don't accept Medicare because of that. It's all very complicated and sometimes very corrupt within the medical system here. In the end many patients suffer because of it. I wish all of you in the UK and other countries could trade places with some of us here in the USA and see what it's really like for some of us. You wouldn't like it.
Spot on ! As I tried to point out, would the insurance companies in the USA be funding a procedure that wasn't more efficacious than a catheter ablation (at a higher cost), without long-term evidence of its efficacy? I doubt it !
Sorry to go OT, but as someone benefiting from the US healthcare system, I'd like to give some balance.
Yes, US healthcare and Medicare have some faults, but my experience is very different from Belindalore's.
Most doctors do accept Medicare and almost all doctors at the major teaching hospitals do. And that's where you would probably end up getting an ablation.
The US system also allows me the benefit by choosing my own doctor and having second and third opinions, also of my choosing. There are also no long lines for ablation. Average wait is around 4-6 weeks. The procedure and all related costs is free with Medicare and a supplemental.
Are doctors in the US profit driven? I'm sure many of them are, but that doesn't mean they necessarily don't do good work. Some of the most expensive lawyers can also the best, for example.
But I think the real stretch is that the reason WMM is not more popular is because ep's would rather do multiple ablations. I think the real reasons are stated here and in some other recent threads.
Don't mean to say one medical system is better than another, both have plusses and minuses, but just wanted to give another perspective.
Yes. You do get good healthcare I'm sure. Do you have an HMO? Probably not. Because if you do and you can't afford the better insurance you get quite different treatment. Good for you for being able to afford the better insurance. And being able to choose the Drs you want etc etc. Not all of us can.
Yes. And you mentioned "Medicare" in your post so I was just responding to the advantages of conventional Medicare, which I have. And yes, with HMO's and Medicare type HMO's, your choice of doctor's are more restricted. I didn't say the US system was perfect, or equal for all, just trying to give some balance. Out of respect to the the OP and group, I'll make this my last comment since we are off topic and debating the merits of one healthcare system versus another can go on and on.
Hope your exercising is bringing a smile to your life !
I wanted to add that the WMM is wildly successful.
Dr Wolf is booked up till September, from what I see on the FB site, and is doing up to four surgeries a week.
People don't realise hat the time in the operating theatre is a fraction of the time that a surgeon needs to interview patients, read medical histories, follow-up recent patients, analyse the Linq data, post the weekly seminars, read up on the latest research (as all professionals are required to do), prepare for surgery, etc. etc.
The worry that people have, who are interested in the WMM for the future, is that Dr Wolf is 68 and will eventually retire !
Wolf's procedure is almost 20 years old. Not saying it's dated, but I think some of the slack at Wolf's retirement will be picked up by surgeons and ep's doing hybrid surgery which arguably has advantages over just a mini maze and where peer review will help us make better decisions. Assuming that even newer procedures don't come along making it mute.
But if the WMM is really that ground breaking and special, then it's a shame he hasn't gone peer review and/or trained more to take over. I understand that there might be reasons. And perhaps only a handful of surgeons are motivated to take on what appears to be a long learning curve, but you would think that in 20 years, there would be more than just two. And the fact that surgeons are now starting to do Hybrid's suggests that it's not a prohibitive skill set.
And as I've mentioned elsewhere here, I've been burned on Amazon many times, buying just on testimonials. And again, where this 95% success rate coming from? I don't even see it in the study Wolff sent to Jajarunner. You've looked into this longer than I have and maybe I'll change my opinion at some point, but not sold yet. At this point, more interested in the newer Pulse Field Ablation. Keep up the good fight.
Jim, we come from the same starting point and looking for the same end point - wanting to be AFib free and in NSR, to do what we did before.
I have no idea or knowledge how the peer review is sourced and the mechanics.
Sometimes, we have to extrapolate and look at the bigger picture:
a) Houston Methodist is one of the leading hospitals in Texas. Would they put their name to a wishy-washy procedure?
b) With hundreds of gushing testimonials, are they all paid actors?
c) Dr Wolf is the co-inventor of the AFib bipolar ablating clamp that started AtriCure- a $2.8 billion company that markets the tool to hundreds if not thousands of surgeons.
d) Dr Wolf is, very probably, a multi-millionaire having done some 2.5-3,000 procedures. Is he so greedy to still be marketing a procedure that was only half successful?
e) The WMM is financed by most US insurers. Would they do that, at a much higher cost than a catheter ablation, were it not more effective in the long run (they would not fund it if if needed repeating).
This is my starting point for my thinking.
I then look at the (un)success rate of catheter ablation - probably half Dr Wolf's patients are post 2-3 and more failed CAs.
I look at the continued risk of stroke after CA and the need for AC. Dr Wolf ablates the LAA and the risk of a stroke from AFib is lowered by 96%.
I then look at the need to be taking rhythm control medication after CA.
I then look at micro clots that end up in the brain after a CA, which allegedly are eliminated after a period.
Were I to decide on such an important matter, I would have a virtual meeting with Dr Wolf that costs just $95, I believe.
I had an hour virtual consultation with Dr Sanjay Gupta that cost £145 and was told to take the anti-coagulants with the medication and I would then have nothing to worry about....
I have no connection, whatsoever, to the WMM.
I would like to wean off the AFib without surgery or medication, and am working hard on it by reading books, researching, communicating with past patients, and by speaking to each other to find out what might work for me and sharing my findings.
I hope that you are well and fighting the good fight !
Saul said: "I would like to wean off the AFib without surgery or medication, and am working hard on it by reading books, researching, communicating with past patients, and by speaking to each other to find out what might work for me and sharing my findings"
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Now wouldn't that be great! And please keep on sharing. Or maybe something better and less invasive will come along. I did read about a vagal nerve stimulating device that was trialed but the author felt I may not be a candidate as my afib is too entrenched and mixed with structural heart changes due to age.
BTW I'm on a lower dose of flec, so off diltiazem now. Feels nice to have my heart beating a little more naturally when exercising. Anyway, going out now for a walk and to get some natural Vitamin D!
Good luck Jim. I really believe that I can make AFib just a minor niggle, and am proving it to myself. Ten weeks of exercising - admittedly at lower intensity than before - and I am seeing the benefits: less medication, less frequently, quicker conversion after an episode, and most importantly for me a renewed confidence and less worry !
Enjoy your lovely day !
For dessert, please watch Dr Wolf speaking to one of his very early patients from 2004 (now 90 years old who looks 75) after 17 years in NSR - post WMM.
You should listen to DR Wolf’s last video cast on his website. Where he breaks down the actual success rate based upon how much AFib you have and for how long. 95% success rate applies to PAF for less than a certain amount of years.
Unfortunately the alternative is total dependence on a pacemaker. This seems to be the normal course with afib. When I was first diagnosed I was told it wasn’t that serious, to just live with it. Now it seems the medical establishment sees the progression of afib. I’ve followed many on various forums who are now totally dependent on a pacemaker.
Pacemaker for me was the answer and has been for several of my EP’s patients, without total dependence. I still have very occasional AF, 3-4 episodes in 4 years which don’t last long and are not that symptomatic. I have other health conditions which are far more concerning.
There are many pathways to NSR and anyway not all will chase that Holy Grail for many reasons. My Dad lived with AF and none of us knew it. He lived a long and energetic life, despite serving in Burma in WWII and all the accompanying traumas, drinking heavily, partying till dawn at least once a week, as did his contemporaries who all lived well into their eighties. It was his kidneys that failed. We only found out he had AF after his health records were released.
For many like me PM was my only option as I can’t have the drugs, sedation or a GA. PM was implanted under local anaesthesia with IV Paracetamol. My AV node remains intact by the way and I’m only about 10% dependent.
I’m glad for anyone that finds relief for AF that wants or needs to but I’ll never be a taker for a surgical procedure for a none life threatening condition. 10-20 years ago I may have made different choices.
I’m not sure there is a ‘normal’ course of AF but agree that there are more treatment options out there and for that I guess we are all thankful for the ability to be able to choose, if you have the access to resources to pay.
Thank you JJ and Mummyluv for all your research, and for sharing it. Very interesting and informative!
It seems that bringing in a surgeon to ‘reach the parts that catheter ablation can’t reach’ is increasing and having some success!
I hope this results in EPs and surgeons working together. To my mind the two stage hybrid process is more likely to result in each opting for their own ‘one size fits all’ but I hope I’m wrong!
It’s a while since I looked at the WMM website but I don’t think he excludes the need for some more ablation work or continued medication for some patients. I think he just does what he does and probably very well. Others can disagree!
I totally agree! In my case I was booked for Houston before finding a U.K. surgeon and as I am long term persistent Dr Wolf said I may need touch up catheter ablation, he works closely with an EP at Houston Methodist.
The U.K. surgeon doing my Mini Maze this week works closely with an EP too if follow up is needed. It’s essential that the surgeon and EP understand each other’s procedures well. Very interesting debate on whether they should even do at the same time in the videos I posted. For - can see different things and work as a team on where to ablate, Against - the surgical scarring does not complete for 3 months and so it is more beneficial for the EP to do his work after 3 months to avoid unnecessary work.
I too hope that more surgeons and EPs work together 🤞🤞 it’s starting to happen.
Thank you Jajarunner for following up and posting,
A lot of great points! But one point not directly touched upon yet is the 95% plus success rate that's been touted here. Isn't that why so many people are drawn to the Wolf procedure in the first place? Because it's like a slam dunk?
But where does that number come from? It doesn't come from the one study that Dr. Wolf emailed to Jajarunner. It doesn't come from peer reviewed studies, because they don't seem to exist. And now we hear from someone in the forum that Dr. Wolf works closely with an ep who does "touch up work" via catheter ablation. Didn't another advocate here for Dr. Wolf just call catheter ablation "barbaric" in another thread?
And does this catheter ablation"touch up" work figure into the success rate figures, or are these figures without the touch up work? Unfortunately we will never know because again, no peer reviewed studies. And the one study we are presented with only goes out 1-2 years.
Like Jajarunner and some other have stated, no one is saying the WMM is not a good procedure. We're just saying that we don't have enough vetted, independent information to say one way or another. And the conflict of interest ban from a major scientific journal is concerning,
Testimonials can be useful, but they are not a substitute for peer reviewed studies and sometimes can paint a misleading picture, which anyone who bought a five star rated product on Amazon -- and then was disappointed later -- can attest to.
Personally, I'm at the point where I'm exploring all options for ablation. I haven't fully discounted the WMM yet, but I certainly have more questions than answers now. And I want to again thank Jajarunner for that. Because the more questions we raise, the better the decisions we will eventually make.
The “touch up” ablations needed are very few and far between. The reason that they are needed at all is due to people having multiple ablations before the Mini maze or who are in persistent or permanent AFib sometimes end up with atrial flutter in the right atria which is not addressed in the mini maze. Most of the time if they get it it can be cardio verted and never comes back. On a rare occasion they May need an ablation on the right atria to stop it.
Yes, and they are also needed when the arrhythmia is based on the right side of the heart, regardless if a previous ablation has been performed.
Here again is why I would like to see some study data because according to the Frankel Cardiovascular Center at the University of Michigan "RF ablation enables all types of arrhythmia's (other than afib) which can coexist in up to 30 per cent of patients, to be targeted". Many of these on the right side of the heart.
The inference, since they are comparing cryo balloon to rf, is that many of these arrhythmia's are on the right side of the heart, while the cryo balloon (and the Wolf MM) only deal with the left side of the heart, unless combined with RF.
So when you say, "very few and far between", exactly what are you basing it on? What are the studies? What is the follow up? Is Dr. Wolf deeming the procedure a success if patient is afib free only, or if the patient is arrhythmia free?
In my case, I have bouts of aflutter (and previously SVT) that likely come from the right side. So I would want any ablation I have to address both sides of the heart at the same time to potentially avoid a second procedure. Most catheter based ablations in the US, as well as the Hybrid's, address both sides. WMM does not.
Yes there are sometimes arrhythmias on both sides. The Mini maze only address the left atrial and that is stated by Dr Wolf. His belief is that most lone AFib is vagal AFib and that is what he bases his procedure on.
So everyone has to do what is best for them and not everyone is a candidate for the WMM.
I was giving information that has happened with patients who have had the WMM.
The recovery from the WMM is more difficult than an ablation that’s for sure and takes a while for the heart to heal. My biggest factor in deciding to do the WMM is I know my AFib is vagal based on my triggers and I don’t want the inside of my heart burned up and micro particles traveling to my brain which is what happens with an ablation. I also do not like the odds for success in an ablation. But that’s just me. Everyone has to make their own decisions.
Thanks for the info. I was referring to the Wolf Mini Maze which seems to be promoted as something apart from other procedures with only two doctors doing it according to at least one poster here. With WMM my understanding is that a "touch up" catheter ablation on the right side might be needed in a few cases because they only treat the left side. I know your ablation was not WMM. Did you have the hybrid or how did they deal with the right side of the heart. Isolating the pulmonary vein whether by catheter or mini maze is on the left side traditionally. Hope you are recovery well!
I will ask that question I am not sure exactly. It has been filmed though as I wanted a copy for my local cardio team who were not keen I did it so will be able to see very soon 😂
I knew you were referring to WMM here, was just sharing 👍👍
Thanks. It will be of interest how the right side is dealt with or not. And if you post a link to the video, we can all get out the popcorn and watch
FWIW I'm still open on all procedures be it RF, Cryo, the newer Pulse Field, Hybrid, MiniMaze like you had and even WMM, although all the claims and promotion by Wolf and others give me pause.
So very appreciative of you sharing your story and detailing your mini maze experience without overselling it and without putting down other choices.
I’m actually very grateful for the promotion of Dr Wolf. His videos. Education Q&A and the Facebook group his patients lead has opened my eyes to there being a surgical option for persistent afib. Then it is up to each of us like you are doing to research and work out what is best for us as an individual xx
I mentioned the touch up ablations and it was specific to my case as I have long term persistent where cardioversion has been unsuccessful as have drugs (even Amiodarone) and I’ve had one failed catheter ablation so there is a risk that this will be very stubborn and need some additional ablation where surgery can’t reach. This approach is consistent with the view of the U.K. surgeon doing my procedure on Friday.
Highly unlikely anyone in paroxysmal would require a touch up.
Hopefully you will see my previous comments as to the actual success rate of the WMM that Dr Wolf states in his most recent video presentation on his website. Wolf mini maze.com
So, now you decided that Dr Wolf is part-time; based on your intuition or psychic abilities, I bet - forgetting that Dr Wolf interview hundreds of patients, reads their medical histories, subjects them to half a dozen medical examinations before the WMM is performed, follows up the data from the implanted Linq monitors in hundreds of patients, etc all in his spare time.
Dr Wolf is the inventor of the tool which made AtriCure, which is a billion dollar company that sells the instruments to hospitals all over the world with subsidiaries in Europe and Asia. He is probably a millionaire, as most cardiac surgeons the world over, and I don't begrudge him a penny.
We move in different life trajectories, I'm afraid.
When I read at least a hundred testimonials from patients who are gushing about Dr Wolf, again and again, and the benefit his procedure has brought to their lives, my ears prick up.
I have never come across a gushing epistle to the EP who performed a catheter ablation - on any web site.
Dr Wolf is a pioneer of the Mini Maze procedure. I could link these to you, but I shan't.
You have to do your own research and convince yourself all by yourself.
I also believe your information is incorrect. Perhaps you could listen to what STOPAFIB.org has to say as they interview Dr. Wolf back in 2012...youtube.com/watch?v=KxwYHpz...
I follow the wolf mini maze Facebook group and if you want to see what he does daily, you can. New patients post the dates of their apt. The dates of their surgeries, the times they meet with him prior to surgery, the results of testing, pictures of them with Dr wolf after surgery, their follow up prior to leaving Huston, insertion of link, etc. the day before my testing, I met with him at 830 and followed on the Facebook group what he did that day. He’s like Superman. Not sure why anyone with the funds to go and stay in Houston wouldn’t be open. It was expensive to fly and pay for losing, etc but so worth it. I’ve had two ablations and six cardioversions. I was tired of living with afib. The recovery was harder than the ablations but I feel so good now.
I had an ablation 11 days ago which thus far is working.
Before I had it I asked my cardiologist about the maze and was told that unlike an ablation in order to do the mini maze they had to cut the chest open. Is that true?
No that is not true. A true maze is done when someone is in open heart surgery for some other problemAnd they do it while they are in there. The mini maze is done through key hole
Incisions under each arm for the tools to go in and is done on a beating heart. No heart lung machine or anything.
My understanding is that a maze is open heart and a mini maze is through the ribs. Others on the forum may know more details. Glad your ablation is working. All the best
I suspected that was the case. If my cardiologist was either more knowledgeable or more honest it wouldn't have done me any good anyway as my medical is in the US through Kaiser which works much like the UK medical system. For the ablation I had to get on a long list as there's only one electrophysiologist at Kaiser in my state of Hawaii. When it was my turn I had to fly to Oahu, the main island and fly back home two days later.
It sounds like I'm complaining but mostly I'm just thankful it got done.
I understand. I had Kaiser before I got on Medicare. It’s ok as long as you are young and healthy, and when I started having AFib I could not even get them to send me to a cardiologist because my holter monitor didn’t show anything which a lot of time they do not. I made dang sure when I got in Medicare that I DID NOT have Kaiser advantage as a supplement. I couldn’t get out of Kaiser fast enough. I had to deal with them with both my parents as they aged and it wasn’t pretty.
The factors for keeping Kaiser when on Medicare in Hawaii are different than for those who live on the mainland. For access to all specialties when you live on the out islands you either have Kaiser or you get on a plane when you need the specialist. With Kaiser, if the specialist doesn't live on your island he visits regularly. The experience that drove me to Kaiser was when the one ENT on the island realized that he couldn't make a living here and moved back to California. As an audio professional with occasional ear problems I had no choice.
Wow. I understand! You have to do what you have to do. It’s unfortunate it’s that way but it is what it is! I wish you the best of luck in your recovery.
Standard of care is ablation. They are done by an electrophysiologist and I rarely have heard of one lasting longer than a year or two and you still have to be on blood thinners. This procedure has to be done by a cardiac surgeon. Having worked in a hospital, I know how slowly things change. Plus if the wolf mini maze was more prevalent , then a lot of Electrophysiologists would be out of a job. I’m just so glad I found out about it when I did. Dr. Wolf is 68 years old and close to retirement age.
Absolutely!! In a heart beat! (Pun fully intended)
Reply7 h
Tammy Gonzalez
Only 7 days out, but so far yes!
Reply7 h
Darin Swenson
YES!
Reply7 h
Diane Juhasz
Without a doubt. Persitent afib and always shortness of breath, no energy. That's gone now.
Reply7 h
Ginger Shriner
Most definitely.
Reply7 h
Margie Cary
Yes
Reply7 h
Lisa Ammons Pearce
Yes 💯...no doubts. I am delighted and blessed
Reply7 h
Mary Price
Yes!!!
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Bill Jynella
Hell yes!
Reply6 h
Sandi McMahill
You betcha.
Reply6 h
Gloria Hegemier Morrison
Two weeks out today. Yes Will be happy when energy returns n
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Lisa Ammons Pearce
Gloria Hegemier Morrison give yourself about 3 or 4 weeks. You will be chasing rabbit's!!!!!
Reply5 h
Gloria Hegemier Morrison
Lisa Ammons Pearce hope so. Thanks
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Lisa Ammons Pearce
I went to Disney at 6 weeks with my 3 year old Grand !!!! So no worries it will happen.
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Brad Agnew
I annoy the hell out of people. I see people I have not seen in a while and they make the mistake of asking how "My heart thing is going". Most people actually are amazed to hear about the process although their eyes glaze over because they dont really understand it.
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Gloria Hegemier Morrison
Brad Agnew boy that’s the truth!!
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Andrea McGarvey
Brad Agnew I do the same Brad. They make the mistake to ask by golly they’re going to hear about it.
The original post was about lack of peer reviewed clinical studies. Nobody doubts the WMM works as the FB states, but that is not a clinical study albeit impressive, which is what I was talking about.
Here is the deal people. Peer review is very time consuming (years), and expensive. (Ive asked and the involvement is 3 peoples full time job for quite a few years) Im sure he is more concerned with helping people that want to be rid of AFIB with his WMM that he has been doing for nearly 18 years now, than to spend his time and energy on a piece of paper for someone else to say , oh yeah this is good stuff.
You want to know if it works? FINE ... go to the source. All of us patients, nearly 3,000 of us, or the 2,000 in Japan that now are in Normal Sinus Rhythm. There is your "proof". None of us are paid, or on any form of payroll. This is word of mouth. When something is this good and it works, people will talk.
Compared to all the failed ablations that are being done every single day, the complications, the scaring of the inside the heart. Two,Three, Four and more ablations and still in AFIB. The micro bits that travel to the brain from having the ablations. Then there are all the meds for rate and rhythm with side effects and cost; tired, rashes, and you still have afib.
Then there is the blood thinners. Are you kidding me? My biggest fear because I am so accident prone; fall and get a brain hemorrhage, internal bleeding, and the Anticoagulants are only about 65% effective for stopping a stroke. And they are very expensive.
Look, Im sorry this is not being done all over the world. I hate that my family and friends in the UK and Australia and Greece do not have this available to them. It totally sucks.
But do not put down what you do not know. No need to throw rocks while your living in the glass house. If this was available to you in your hospital by this doctor, just how many of you would be there to have it done??? You would line up in a AFIB heart beats. You know you would, because you know this works.
All Im trying to say is; this Doctor, Dr. Wolf in Houston Texas (not my favorite state at all by the way) he does this surgery to help people, live the lives they were intended to live. He has been doing the Wolf Mini Maze for a very longtime. Get your doctors educated on his procedure. Ask them why they are not learning how to do this, and why this is so different than what they are doing now. Make a little noise for change. Everyone deserves the right to make an informed decision on their bodies. The WMM is HOPE. Which of us would dash away someone's hope for a better life?
Wow, just wow. You truly know nothing about Dr Wolf. He does 4-5 procedures a week plus the open heart surgeries he does as a cardiac surgeon as well. The days he is not in the operating room he sees patients in his office and makes virtual post op follow up phone calls with his patients who travel from all over the world for his services.
“ no one is having a go at him or his procedure”? I for one had a go at it 4 years ago as have over 2500 others. Best decision I ever made after three failed ablations. I am afib free and take no medications. He is booked out a full 6 months doing 3-5 procedures a week. I am where many hope to be. There are many Drs now doing versions of Dr Wolfs procedure in many states and countries. He is just the innovator has been doing it the longest and so more well known. I am an RN and have spoken with many around the world trying to help them find their answer however they obtain that. I find the few that are hostile and doubting are unable to have this done. This procedure is becoming more well known even tho Dr Wolf has been doing it for 18 years. There are thousands of EPs to one cardiac surgeon trained in this technique. EPs will not advocate it even if they know about it. It’s a one and done procedure not requiring multiple ablations to get results if any. You get off all meds and a blood thinner. If you would research you would find several Drs in Europe and in the states performing this.
I think we are here divided by a common language. In England "have a go at" means to criticise it does not mean to participate in, which is how you understood it
coming of all the medications and his success rate is enough for me to consider mini maze. At 46 i don’t want to take blood thinners for the next 20+ years. The potential harms from long term beta blockers and blood thinners and it’s life restrictions makes mini maze and clip a far more sensible choice in my mind.
exactly my reason for having the mini maze. Unfortunately I didn’t find Dr Wolf until after I had three failed ablations or I would have chosen it first. Almost 5 years now. No afib, no meds, no blood thinner and no fear of a stroke.
To me this is great hope and perfect sense. Many will say that the mini maze might look barbaric in light of future developments in treatment, but I would like to live the next ten years in which I’m young and fit without medications that are damaging me.
it is by no means barbaric. It is not an open chest procedure. I had two small incisions under my arms through the ribs and a couple of scope punctures. It is all done on the outside of the heart. I would do it again to be where i am today. The medications alone were slowly killing me and i worried constantly of having a stroke. The left atrial appendage is clamped during the mini maze and you never need a blood thinner again and it lowers your stroke risk to 97%. Do you live in the states? If you do I would love to help you. If you are in the UK there are Drs doing a similar procedure called a convergent hybrid done a bit differently but also offering great results. MummyLuv who posts here has had one within the last year and has done splendidly.
Thank you for the information. I am in the uk although I have family in the US and used to live in New Jersey as a child. I’ve been watching all of Dr Wolfs YouTube videos. Your message and belief in the procedure offers me a lot of hope. As do the many testimony’s of patients who have received themini maze. I feel entirely the same about the medications especially the blood thinners. Since starting a beta blocker and Eliquis I feel a lot worse than before. Obviously at 46 with a ten year old son and busy family business having a stroke is terrifying, but so is accidentally banging my head and haemorrhaging. I’ve developed an auto immune disease lichen planus which I’m convinced is because of the medications. I cannot pursue the sport I love and have spent the last 35 years doing. I have spoken to mummyluv and she has also provided me with with great information and directed me towards Dr Hunter who did her procedure.
I know for some people the medications are well tolerated and ablations work. But I’m in persistent AF and have likely been persistent for over a year or more, undiagnosed thanks to the pandemic and a complacent GP. I can’t see how having multiple ablations, likely spread over years, is either cost effective to the NHS or appropriate considering it’s 50-50 success rate for persistent sufferers. I would also be on blood thinners for the foreseeable future. Thanks for the hope and support. I intend to gather as much information as possible and present it to my GP.
Exactly, why does Dr Wolf not hand his data over to a university who would be glad to turn it into a case study to be peer reviewed. There are so many things to consider for example 'selection bias' whereby only certain people are allowed to have the procedure for example, someone mentioned they were " approved for the procedure" (or words to that effect) which COULD be an instance of selection bias, but also may not. This happens with other types of procedure whereby people are excluded for a reason ie BMI, age, health status and then would affect the results. John is entitled to ask for independent scientific verification regardless of all the wonderful personal testimonies out there. It does not mean he or I are "having a go" at Dr Wolf
I only mentioned my Rn status because in your previous comment you asked if I was his PA/secretary. I know Bambi and her surgeon husband and like many other Drs and EPs he did not know about the procedure when it was presented to Bambi as an option to treat her afib. But being the medical professional that he is took the time to study it and find out about Dr Wolf. I don’t understand the condescending attitude when someone is trying to help others. Dr Wolf gave me my life back and three weeks ago I came to Houston with my daughter and Son In law for him to have Dr Wolf perform a mini maze on him after two failed ablations. On the pre op cardiac cat scan they found a birth defect that was not discovered on two previous cardiac cat scans prior to his two ablations. Dr Wolf could not perform the mini maze and an open chest procedure was needed with another cardiac surgeon who specializes in birth defects and Dr Wolf to do a full maze procedure. There were also two other patients this week as well who followed the same path. Issues not found by their own Drs that and they needed open heart as well. I rest my case.
Are you an EP? Cardiologist? Some other type of Medical Professional? Engineer? Academia? I'm a newcomer to this page and would like to know your background in order to be able to better understand your point of view.
You didn't answer my question. I'll be more direct: What level of education do you have, what is your field of endeavor (what do or dod you do to make a living), and what is your age? Yes, it DOES make a difference in how I interpret your opinion and posts.
Liam1977, what axe are you trying to grind? Surely it does not matter what country you live in, what level of education you have, where you were you have been educated, or what IQ you have.
This thread is regarding the lack of scientific method behind the claims made for the wolf procedure I.e you conduct research, or in this case carry out procedures, once that is done you publish results , or publish efficacy and then leave this to be peer reviewed. As far as anyone can find on the Internet, there are no peer reviews of the claims made of the wolf procedure.
That does not mean it does not have the claimed level of efficacy ( I'm not saying it doesn*t), but peer review of the claims would make them more robust.
As the old saying goes, if something seems to good to be true then it probably is. Unfortunately without peer review the claims of efficacy for his procedure, are somewhat in this category.
Incidentally I know for a fact Dr Wolf has been asked for sources of peer review directly and he himself was not able to provide any.
As a total aside, this is a forum for people to share experience and offer support, not question people's background and attack their points of view.
For the record I have a degree in Astrophysics and I teach in secondary education. Does that deem my opinions as worthy of your respect?
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wolf mini maze / query 
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