A couple of days ago, members have asked for a peer-reviewed publication regarding the success rate of the Wolf Mini Maze.
The document that was cited two days ago was a generic paper about mini maze procedures, and not about the Wolf Mini Maze.
There follows an extract from a review published last year, written by Dr Wolf, the originator of the Wold Mini Maze and the co-inventor of the Atricure bipolar RF clamp, which is now the global standard for creating transmural lesions on the atria during open-heart surgery.
"In my personal experience, the mini-maze procedure is accomplished in approximately 90 minutes operating time (45 minutes on each side). The patient is awakened and extubated in the operating room. The average length of stay is 2.5 days. Patient activity is not restricted during the postoperative recovery period. The AF-free rate is 92% for paroxysmal AF, 85% for persistent AF, and 75% for long-standing persistent AF.16, 20 Furthermore, patients do not need to resume anticoagulation therapy in the postoperative period unless they have indications other than AF for such therapy."
Peer-reviewed Debakey Cardiovascular Journal Issue No. 1, 1st January 2021.
But "peer" review. I dunno. I mean, first the article is written by Wolf himself and "yes" it's reviewed and published by the Debakey Institute, but isn't that where he works? I'm not sure that is what some of us had in mind.
Plus, no study data at all, just to quote the doctor "in my personal experience". No breakdowns on age, prior interventions, no control cohorts, or how long people have been followed.
All this doesn't mean that the WMM isn't good. It may well be the best choice for many with persistent or permanent afib, It's just some of us would feel more comfortable with more and objective published data, that's all. I know you and some others think differently and that's just as valid an opinion.
In his podcast from yesterday, Dr Wolf refers to this study and mentioned that the Debakey Cardiovascular Journal is peer reviewed, so I went by that...
According to the publications website, the articles are selectively peer reviewed depending on the degree of scientific research vs opinion nature of the piece. Not sure where this article fits in but yes, then it's possible it was peer reviewed. However, still more of a "personal experience" piece than for example a blinded study by an uninterested party.
I watched part of the video and as I have said before he seems very smart and engaging doctor.
This slide is from Dr Ohtsuka's lecture. More information needed regarding the breakdown of the results (type and duration of NSR) and the clinical basis for the claims.
While not commenting on the relative worth and efficacy of the procedure in question, I agree with mjames1 questioning this particular concept of "peer review". In my experience as a research chemist, peer review of publishable research results is not conducted by peers working at the same institution as the author, with whom they might even be on a first name basis! I would think that the apparent quality and innovation of the procedure would warrant publication in a leading journal (with associated anonymous peer review). This smacks somewhat of an internal "newsletter".
Could be. Dr Wolf mentioned in the video that I shared that the Debakey Cardiovascular Journal is a peer reviewed publication. That's really all I know !
My interest is in the dozens of first hand testimonials of past and recent patients, accessible via this link:
Yes, I totally agree. This is a newsletter or article and not a clinical study. It's very interesting, but not what I was talking about in my original post.
Interesting. From the video sounds like he gets 97% from the PAF group, however on the chronic af group (I'm assuming they go into the OR in afib) he performs an electro cardioversion on them. If they don't convert then they don't get the procedure but what appears to be a sham procedure, appendectomy. This is 8 per cent. So if my math is correct, his success rate in the chronic group is 97% of 92% or 89% which is still excellent. However, like yourself, I don't see other patient selection criteria or breakdowns. I was first a little confused why both groups were given an appendectomy but I guess that was a control for the 8 per cent eliminated group. Still seemed a bit strange. Confess I didn't watch the whole video so maybe someone else knows more.
The appendectomy is to stop having to take the AC. The risk of AF stroke with oral AC is reduced by some 64% and some 96% with the WMM closing off the left atrial appendage (LAA), where the blood stagnates and clots can form when the heart is in a prolonged AF episode. It's a must if you want to be off the AC and no Watchman.
Edited:
"A meta-analysis of five studies established the effectiveness and safety of warfarin anticoagulant therapy (21–23). Moreover, a meta-analysis found that warfarin reduced the overall stroke risk of patients with AF by 68% and all-cause mortality by 33% (24)."
LOL. I thought he was removing the appendix as a sham control. But it is interesting that he used unsuccessful CV as an exclusion criteria for the study. I've had three successful cardioversions but my last one wasn't.
Jim, 50% of Dr Wolfs patients now have never had ablations and are in paroxysmal afib. He has however been able to get those in persistent afib for up to 7 years back to NSR. Many do not go into the OR in afib and cardioversion is not done to convert them prior nor would the procedure be aborted for that reason. Clamping the left atrial appendage was huge for me as it reduces your stroke risk to 97% vs 60% on blood thinners. I wish I had been given the choice of choosing the mini maze as my first line of defense prior to three failed ablations that made my afib worse and taking medications that were slowly killing me. After the third failed ablation I was told my only other option was an AV ablation and a pacemaker. I’m an RN and I refused that option knowing pacemakers should be used for very low heart rates and long pauses. They should not be used to treat afib. However an EPs scope of practice ends with meds, cardioversions , ablations and pacemakers. I went on to have a Wolf mini maze and it’s now 4 years and I am afib free, take NO meds including a blood thinner and I am not pacemaker dependent. I admin the Wolf mini maze Facebook site. You can read the many success stories there and the trials and tribulations during recovery that we all went through to get to that finish line. I’m happy for anyone who obtains NSR no matter how they do that. This was just my answer and the answer for countless others. Hopefully more and more Drs will will be learning this successful , more permanent way of treating the beast that is afib. Love these forums to share opinions and stories.
Bravo to you ! Personally, I would not wish to have a catheter ablation in the future, because of the scarring inside the heart, the hole that is made in the septum, the risk to the Phrenic nerve, the need to continue with anti-coagulants after the catheter ablation, and the possible mental effects due to micro-clots.
In my opinion, it is an incomplete procedure and first-time results are around 50% success, which is a health gamble.
The figures I get from studies and ep's I've talked to is closer to 75% success for PAF with the first catheter ablation and higher with a second touch up. A NP at a trial site for Pulse Field Ablation was saying they were getting closer to 80% success for PAF. Of course, study participants are a bit cherry picked so I assume those with some structural defects were not in the trial. Success rates for persistent were lower but by memory in the 60 percentile range.
Hi Jim. It's very possible. I initially looked at CA and the convergent procedure (dual mode) and was even in touch with the Maastricht (Netherlands) hospital, but decided against.
It is reasonably priced, some 30,000EUR for the convergent treatment.
I got the CA statistics from a cursory literature scan after several years, not just after one year, which indicate lower success rate, but even if it were more successful, it is still incomplete for me.
The PFA does sound good because it spares health tissue and nerves and I believe that DR Wolf might consider it as a replacement for the bipolar tool, if I read that right in the Debakey Journal article where he mentions the pulsed field technique.
It still leaves the problem of the LAA closure and I would no want to have the Watchman plug inside the heart...
EDIT: Just saw your study. Yes, rates for persistent afib lower. But they are getting 75-80% for Paroxysmal afib.
Yes, Pulse Field Ablation does sound promising. So is Dr. Wolf going to use it instead of his current clamp to isolate the pulmonary veins? If so, other than a different entry point, would his actual procedure then be identical to a catheter delivered Pulsed Field Ablation with the addition of the LAA closure or will he do more?
Jim, the CA stats (see later post) were for persistent and very poor (just 20%) after one CA.
If you read between the lines in the Debakey article, it appears that Dr Wolf is open to using a different energy source if it proves safer. It was purely my extrapolating from his text, I have never spoken to him, just communicated via email with Dr Ohtsuka who was very kind to me online and invited me to Japan to have the WO procedure.
I imagine that it might be possible to adapt the clamp to Pulsed Field and everything else stays the same? just guessing.
"Arrhythmia-free survival rates after a single catheter ablation procedure were 40%, 37%, and 29% at 1, 2, and 5 years, respectively, with most recurrences over the first 6 months. Patients with long-standing persistent AF experienced a higher recurrence rate than those with paroxysmal or persistent forms.
In all, 175 procedures were performed, with a median of 2 per patient. Arrhythmia-free survival following the last catheter ablation procedure was 87%, 81%, and 63% at 1, 2, and 5 years, respectively."
The study was for 175 patients and a mix of PAF and persistent AF.
The results I quoted are for the PAF and not persistent, which were less successful.
As you know, it very much depends on the skill and experience of the practitioner.
Dr Wolf reported on 3 patients just this week who had prior CA and when he did the WMM, he discovered that some of the pulmonary veins were zero isolated - nothing was done !
You can read the patients own report on the WMM forum.
It's OK. The more we challenge stats and studies the more we learn. That's why a number of us would like to see more coming out of WMM than testimonials
Anyway, from Cleveland Clinic:
" In a recent study¹ of 831 patients who underwent AF ablation at Cleveland Clinic, 81% of patients with paroxysmal AF were arrhythmia-free while off anti-arrhythmic drugs at 12 months post ablation."
I've also read up to 87% success at the ten year mark if you include touch up ablations.
Lots of study data, some conflicting and it can be confusing.
Just for the record, I'm certainly not the poster child for catheter ablation nor do I advocate it for everyone. In fact, I have so far resisted any type of ablation but am keeping my options open and trying to make as informed opinion as possible about those options.
Discussions like these are helpful in that regard.
Bravo, Jim. A slightly belated reply due to the Greek clock.
We could almost be twins by age and life outlook.I will also avoid a surgical intervention, if I can help it.
As you know, I believe in exercise and pacing myself, and it's good so far.
As to the studies, it's been mentioned before that the results are contingent on the establishment, the EP, and the experience and numbers of procedures performed by both.
I am with you, and wish you good health and a positive heart !
"The mean follow-up duration was 59±16 months after the index procedure and 44±22 months after the last procedure. A total of 1042 procedures in 493 patients were analyzed (321 patients with ≥1 procedure) with a mean of 2.1±1.1 procedures per patient. Five-year success rates were 20.1% after a single procedure and 55.9% after the last documented procedure, respectively (Figure 3A and 3B)."
Note that the results are after 1-3 CA procedures at 55.9% success after 43-75 months, and most probably not Pulsed Field, which is more recent.
These are also persistent AF patients, which you are not !
I wish I hadn’t agreed to 3 ablations Saul. It was after they told me nothing else could be done and I would need an AV node ablation and a pacemaker that I became my own health care advocate and found Dr Wolf and the rest is history.
It's wonderful to be AFib free for 4 years. I am happy if I can have 10 days free.Although, since I started with the exercise and Vit D3 intake, the episodes (this morning) last just 20 mins.
I find that stress is a contributor and opt for the placid life. All the best. Saul
That's a terrific story and thanks for sharing. The cardioversion protocol I was referring to was part of Dr Ohtsuka's study posted earlier by Saulger. I guess Dr Ohtsuka's was using it as some sort of barometer as to the potential success of the procedure but I don't know on what basis.
Saul, if I may ask, have you discussed the WMM with your EP, cardiologist or GP ?
I have not but am scheduled for 6 month evaluation next month.
Real peer review would be if WMM was a more widely practiced and referred procedure. I don’t subscribe to theory too difficult, others don’t want take time to learn, etc
Hello Mav. No, I have not because I am not seeing a cardiologist or an electrophysiologist, here in Greece.I was diagnosed in 2018 and started with 1.25mg x 1 Bisoprolol for a few months, and was fairly symptom-free. My episodes were happening after exercising too hard and I gradually stopped over-exerting.
On and off I was on 50mg x 2 Flecainide and that helped, but I was still getting episodes.
About three months ago I read on this forum that taking 100mg + 1.25mg Flecainide before exercise, allowed training without episodes and that's what I have been doing.
I since dropped the level of the medication, both frequency and dosage, and mix them up, according to how the heart seems to be reacting (rate or rhythm).
I am doing well - touch wood !
I feel that some exertion of the heart is helpful to become more resilient with heart rate variability. I stay at HR 100-110 (average 96) for 45 minutes on a rowing machine, and not higher and I am better now with fewer episodes of shorter duration (some resolving well under an hour).
I should add that I also read that low vitamin D3 could contribute to AFib and have been aiming to up my value from 31 ng/mL to 64 ng/mL (not tested yet), which was recommended by a sufferer (Australian Steve Carr) who manages the AFib without surgery or medication - just diet, supplements, and exercise.
I should add that I am 75 with lone AFib which is paroxysmal with no co-morbidities
I don't take a blood thinner because I believe that I am CHADS score one.
Forgive me for the rambling reply.
To answer your question, I have been following Dr Wolf and his WMM for a couple of years and read dozens and dozens of testimonials that are gushing, almost conferring sainthood on the good doctor.
It is extremely successful and Dr Wolf would not be able to handle more procedures (booked until September). He operates 4-5 procedures a week and also follows up past patients via a LINQ implant.
MummyLuv1 (Alison) from the UK, on this forum, was booked to have the WMM in Houston yesterday, and will be having a Totally Thoracoscopic Mini Maze in London tomorrow.
Alison researched the procedures far and wide and had posted on this forum - please check it out.
I recommend that you join the FB group Wolf Mini Maze - Live Afib Free and converse with the recent patients and newcomers. It is very welcoming and Sandi, the administrator, is an angel.
Many WMM patients were after failed catheter ablations (some 3 and 4), are overweight, many my age, have other health issues- and yet the success rate is very high and no need for future rhythm medications and AC.
Dr Ohtsuka in Japan performs the same procedure and I have been in touch.
Should I not be able to manage my AFib and it becomes too symptomatic, I am well prepared to become a Wolf Cub.
You and I are the same age (75) and similar symptoms, though my AF progressed from the symptoms you are experiencing to persistent. Hopefully, you will have a different result.
Like you, I was an avid exerciser gettting my heart rate up to about 135 for 30 minutes during exercise. This was before the initial diagnosis of paroxysmal AF. Looking back, it may have been a contributing factor. You may want to research.
My AF is pretty well controlled with metoprolol at this time.
Yes, I have been following Mummy's latest events. Hope her procedure is a success.
Hi Mav. Are you in the UK? Alison is having her procedure tomorrow in London (Drs Birdi and Hunter, I believe).The WMM is expensive without medical insurance: $150,000.
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