I live in Houston, TX and have had AF diagnosed for about three years now. I have episodes periodically (2 or 3 times/week) which last anywhere from 1 hour to 24 hours. They are pretty much life limiting with shortness of breath, tiredness, physical activity is out of the question. Then they go away and you feel great instantly! A very strange condition. I was wondering if anyone on the site has had any experience with the Wolf Mini Maze? Dr. Wolf is a cardiologist in Houston and I have an appointment with him in May to explore his procedure. He claims a 98% success rate in "curing" AF. He works at a very reputable hospital so that gives me some comfort. Any feedback would be helpful in my decision making process. Thank you fellow AF'ers!
Wolf Mini Maze: I live in Houston, TX... - Atrial Fibrillati...
Wolf Mini Maze
Most participants here are not from the UK, however several here have had similar surgical ablations. Some members who might be helpful are , saulger MummyLuv 2018NSR 4chickens
I haven't had a Wolf Mini Maze (WMM), but have read some very good things about it. Not sure about the 98% figure, however it does seem more durable than a catheter ablation. As I understand it, WMM only addresses the left side of the heart where afib lurks, so if you have right sided flutter or other right sided issues, you would need a catheter ablation in addition.
Jim
Thank you Jim. I appreciate your input. I'll be talking to my regular cardiologist about it on Friday. It'll be interesting to see what he has to say. I am currently taking 100mg flecainide twice a day + Eliquis twice a day + metoprolol once a day at night. I'd like to get off all these meds!!
Let us know what your cardiologist says, however don't be surprised if he either hasn't heard about it, or he gives you some misinformation. Most cardiologists work with ep's on afib matters and are not well informed on the surgical options, although they are becoming more common in some of the major centers.
Jim
I've never been to an EP which I find strange after reading the posts on this site for a while. My doc just went the pill route and that was that. Maybe I'm not getting the best advice.
Ep's do ablations. They are also best at evaluating you for ablations and/or prescribing meds for afib. On the other hand, they have a bias toward ablation, so you may not be getting the most objective opinion. In your case, sounds like ablation may be the right answer given the frequency of episodes. The other route might be to try a daily anti-arrythmic, like Flecainide, which may also keep you in normal rhythm. But back to the WMM, don't expect an ep to give you much information on it, because they don't do surgical ablations. That said, you probably should speak to one to compare against the WMM.
Jim
Good stuff! Thanks Jim!
Precambrian
(EPs) They are also best at evaluating you for ablations and/or prescribing meds for afib. On the other hand, they have a bias toward ablation, so you may not be getting the most objective opinion.
That said, you probably should speak to one to compare against the WMM.
Quoted for truth.
Cardiologists will just treat with meds as they deal more with valves and blocked arteries etc. EPs deal with arrhythmias and will try to correct afib. EPs are cardiologists with extra training.
Sorry, I missed that you were on 100mg Flec 2x/day. If that isn't keeping you out of afib, then sounds like ablation is the next step. Also, you might ask yourself -- and your cardiologist -- is the Flecainide helping at all? If it is, then makes sense to keep it going until you have an ablation, but if not, why stay on it?
Jim
Was advised adding med like ER dilTIAzem makes flecinaide more effective. Did the trick, when flec and regular ( versus extended release Diltiazem) did not.
Your cardiologist will not be in favor of the mini maze as he cannot do it. He will want you to just stay on meds or refer you to an EP for a catheter ablation. The mini maze has to be done by a cardiac surgeon.
Sounds like is not standard of care, so I'm quite sure my uhc commercial insurance won't pay. Post I saw earlier said wolf mini maze runs 170k ish....unless done in Tokyo by dr ohtsuka (trained by wolf), then is under 20k).
Hello 2018NSR - Your response above is exactly what happened when I saw my cardiologist. Amazing insight!!
i live in Houston also and have an appointment in February with Dr.Wolf but I had an appointment with Dr.Natale (via Facetime) in Austin on Monday and am leaning towards him doing a pulse field ablation. If you search my posts you can see responses from all the lovely people who responded who have had the mini maze. Good luck with your decision…
Thank you Fuzzy! I'll dig up your past posts for more info. Good luck with your journey as well!!
hello Precambrian. My name is Sandi. I am the admin of the WMM site. I am also a patient of Dr Wolfs. I had three failed ablations, countless med changes and cardioversions. I was then told my ONLY other option was an AV node ablation a pacemaker and Watchman all of which I refused. I then had a WMM almost 6 years ago and I remain afib free, take no meds including an anti coagulant and I am not pacemaker dependent. You are fortunate to be in Houston. He has patients out with no afib for over 20 years since he pioneered the mini maze in 2003. The 98% success rate you state is a bit high but he does state 93- 95% success for paroxysmal afib. I’d be happy to answer any questions for you.
In your experience, what is the track record with insurance companies in the US covering the Wolf Mini Maze procedure. I'm a Bluecross Blueshield of TX policy holder. Thanks.
Most insurances cover the mini maze and Medicare does for sure. BCBS has covered and given it is from Texas is a plus. If you want to Pm I could send you the list of insurances Houston Methodist accepts. I also have the insurance codes and you could call your insurance with those codes for a definitive answer.
Th e WMM procedure is generally not available here in UK but Dr Wolfe has many disciples on your side of the pond as well as Japan where he has a colleague working so I'm sure you will get many responses.
yes, many have gone to Tokyo as it is very affordable and an excellent choice. Dr Ohtsuka was trained by Dr Wolf in 2008 and he has done almost as many procedures as Dr Wolf. I know that Drs in the UK are now doing minimally invasive surgical ablations now as well but I understand it is difficult to get accepted for the procedure making Tokyo an excellent choice. Obviously coming to the states is financially not an option for most. Many patients from Canada have gone to Tokyo as there is only one Dr there doing a convergent hybrid procedure but he does not clamp or remove the left atrial appendage which is huge for most wanting to eliminate anti coagulants and stroke risk.
Just a note, EP’s don’t perform Mini Maze - thoracic surgeons do. WMM is a minimally invasive surgery against ablation which is performed via catheter. And there are surgeons in UK starting to do this procedure MummyLuv’s was done in UK.
I live less than 2 hours from Houston and had the WMM a little over a year ago. I learned about him on this site!
I’m off of all meds and my heart is in SR. I wish I had gone to Dr. Wolf when I first started hearing about him. My doctors only wanted me to see an EP, have an ablation and stay on blood thinners and other meds. I gave in and had an ablation in 2018, which brought on flutter, then A-Fib again. I did not want to have another ablation, which was recommended. I have friends that have had them over and over and over…. I wish I would have been able to have the WMM and no ablation. Many people are doing that with great results. Check out the Facebook site that Sandi recommended. She is amazing and so helpful, I am so grateful for all of her guidance and support.
Being in the Houston area you may be able to get on a cancellation list and have the procedure done sooner than it will be scheduled, which may be 9 months away.
Good luck to you. Dr. Wolf is an awesome doctor and Methodist Hospital is the best!
Same here !!! Why did I wait. I was lucky to read a post, on this very forum, about someone (Bambi) who had the WMM and was surfing a few weeks later (don't do it) and the rest is history.
I wish I had been told of the mini maze option up front and had been able to make my own decision as well. Many do well with an ablation. I was not that fortunate. I’m happy you are doing well.
I am one of those in the UK who has had a minimal invasive proceedure carried out by a brilliant cardiothoraisic surgeon Mr Hunter here in the uk who has also worked with Dr Wolf. Mine was very sucessful I'm only 5 months post op but have been in NSR ever since. I had moved to persistant Afib and drugs were not working well for me. EP said catheter ablation was not a suitable option for me. This option is increasingly available in the UK. My cardiothoraisic surgeon went in both sides of my heart so not sure why another member said it is done left side only.
Sandi is great and I really recommend you join her Wolf Mini Maze Group as there are lot of people on there who have gone through it it or are in recovery or waiting. I've found it very useful too and am grateful to Sandi and all those on there.
You are very lucky to be living locally to this highly skilled cardio thoraisic surgeon. I happened to live locally to the UK cardio Thoraisic surgeon renowned for this op too. I'm very lucky and grateful.
I wish you every success.
We have several members who have had catheter ablations and other minimally invasive surgical ablations in our group. The goal is NSR no matter how we obtain that. Dr Hunter is a blessing for my U.K. friends wanting to go that extra step as well. I’m happy you are doing well and thanks for the kind words!
I would recommend the Posts of saulger in which he details his WMM experience in Tokyo, where he travelled from Greece.
there is an excellent wolf mini maze facebook group where you will find loads of patients of Dr Wolf, I found it wonderful despite having my mini maze in the UK as people kindly share their journeys (good and bad) and helps you know what to expect.
You are very fortunate to live in Houston and have access to a skilled cardio thoracic surgeon with ooodles of experience. Go and see him so you can compare your options fully.
Hi Mummyluv
I’ve probably asked this before but if you don’t mind how much did Dr Hunter charge for the mini maze type treatment pls. I’ve had a price for the pulsed field ablation so comparing would be helpful for me. Thanks
It’s nearly 2 years since I had mine so it may have changed. Main cost is the private hospital. Total £35k. If you are in England he will take an NHS referral from your GP
Thanks Mummyluv that’s really helpful. The pulsed field is just short of £20k
So you can consider all your options Dr O in Japan will be a compatible price to your pulse field
Yes that crossed my mind too. Thanks for your help
You can get the same procedure privately from Dr Ohsaka in Japan for significantly less, even factoring in travel. saulger who is posting in this thread, can give you the details.
Jim
Thanks Jim
Btw how is your situation regarding afib two years later pls. Ta
What afib?? Joking aside you always expect it will rear it’s ugly head again but not so far x
Thanks Mummyluv. Do you get ectopics or have they settled as well. Apologies for the multiple questions but it’s really helpful information
Yes still get ectopics. I think most people do. We are just more aware of them.
Thanks
How about your exercise tolerance? Would you say it's about the same, better or worse than before the procedure. And if you can also compare it to before you had arrhythmic issues.
Thanks.
Jim
I can’t I’m afraid as it’s limited just now as need both hips replaced (long story) and so walking is about the extent for me at the moment, first hip being done in 3 weeks. Really looking forward to getting my mobility back and back to exercise 😍.
saulger is very active though and I am sure can answer
Nearly 2 years already!!?
It seems like a few months ago.
I know!! It’s actually only 21 months lol
Time really does fly.
Hello Precambrian. I believe that the success rate, staying AFib free for five years after the procedure, is around 95% for paroxysmal and mid 80's % for persistent.
Because the LAA (left atrial appendage) is removed/clamped, the stroke risk due to AFib is reduced by 97%.
I can recommend the treatment wholeheartedly. My only regret is suffering AFib for five years before having it done in Japan in November 2022.
I had the WMM with Dr Ohtsuka. It is a little different (WOP) the way that Dr Ohtsuka does it, and the end results are the same. Dr Ohtsuka makes small punctures that are virtually gone now, 14 months since my Op. He also does it quicker: 1 hour for paroxysmal and 1:20 for persistent.
I had a very easy recovery and walked over 10kms the day I was flying back.
There is a FB group with 2,000 current members, many of whom have had the WMM in Houston and they will answer any questions that you have.
Good luck. Saul
Saul, you totally aced your whole procedure. I loved following your journey and of others who have gone to Tokyo and those here who have seen Dr Hunter. Always makes me smile reading happy endings.
Phew! That’s very often and lengthy! Have you ever been offered Flecainide as a PIP or regularly? I take that and haven’t had an episode for over a year now.
I can add little to what other contributors have said, join the wolf mini maze facebook group, they’re a friendly lot and tell it how it is warts and all. Your lucky to live in Houston, if the minimaze is suitable you may be able to get a cancellation as I think Dr Wolf is booking about 9 months out.
I’d had 4 ablations before having a hybrid procedure here in the uk, without this site and the wolf mini maze I wouldn’t have known I had an option apart from pace and ablate or another ablation.
My advice to anyone is read, research and ask questions even ones you consider silly, then ultimately make the best choice for you.
There have previously been long and passionate debates about Dr Wolf on here. My concern was there are no clinical studies verifying his results. Even when I contacted him directly he couldn't provide anything beyond links to other maze procedures. He also has various conflicting financial interests which lead to one article by him being removed from a science journal (BJM?) due to him not declaring it.This is not to say he isn't an excellent EP just that scientific proof of the WMM's efficacy does not appear to exist and is just something to be aware of.
Dr Ohtsuka was trained by Dr Wolf and he has printed statistics. Dr Wolf implants loop recorders on most of his patients after the mini maze and can monitor his patients 24/7 for up to 5 years until the battery dies. Being afib free at the five year mark are his statistics as proven by the loop recorder. His very first patient from 2003 remains afib free as do countless others.
Interesting that you say there's no proven research that you have been provided with. I'm surprised and I think it must be out there. In the UK I very much doubt Mr Hunter and others would be allowed to perform this op on the NHS unless there was strong evidence showing its benifits. Every new operation proceedure has to go through a careful screening process by the NHS and can't be performed unless its approved. The NHS often attaches criteria guidance on who operations can be performed on. The mini maze is no exception..
There are many research reports into mini maze and more recently hybrids. The most recent multi site report is called CEASE-AF.
Thanks MummyLuv....I was hoping you'd pop in. 😘
I was speaking about Dr Wolf's specific procedure specifically not the Maze more generally. There is literature for maze but Dr Wolf could not provide me with any for his procedure which I believe is slightly different and only performed by him and those he has trained. I'm sure it works well, I'm just stating that there is no clinical proof, as wasn't last time I asked him.
Just to be clear Dr Wolf is not an EP, he is a Thoracic Surgeon. I just didn’t want people to be confused about that as you stated this on your original response.
You are correct. Apologies for the confusion 🙏
The Maze op is different to the minimal invasive op. I think its best we are clear on labelling to ensure we don't cause confusion. The Maze operation is open heart surgery. Minimaze is keyhole. There are slightly different forms of mini maze as you say but the core of it is the same. Whether these slight difference make a difference to the overall sucess rate of the operation isn't something I know but they do all have a very high sucess rate if the patient is suitable and meets the criteria.
Here are some statistics, Dr Wolf's article was NOT removed from the BMJ. He was only slapped on the wrist for not stating in another journal that he was the co-inventor of the medical device that he used. You alleged this before and it's not connected with the BMJ. Second, Dr Wolf is the inventor of the thorascopic surgery to ablate AFib 20 years ago. Before Dr Wolf the Maze is open-chest. Dr Wolf is the co-Inventor of the tools used in thorascopic AFib surgery, probably by Mr Hunter as well. This company became the huge medical firm Atricure. Third, Dr Wolf performed some 3,000 minimazes, as has Dr Ohtsuka- more than any other surgeon, I believe. There is a 9-12 month waiting list and Dr Wolf is not touting for new patients. The procedure is performed at Houston Methodist - one of the top US cardiac centres, and is accepted by all US insurance companies. Four, there is a FB group with 2,000 current members, many of whom have had the WMM and tell of it to anyone who cares to hear, but all the above is not good enough for you. So be it.
I think you missed my point, which was that he is unable to provide a clinical paper to prove all this. I never said it didn't work or that he was a quack.
And Mummyluv provided you with research FYI. I'm pragmatic....I'm not saying the mini maze is the only way to resolve Afib. Far from it. However it was literally the only way for me....& am incredibly grateful it worked thanks to the talents of my surgeon or I'd be out of options!!
The minimaze and its variations are part of a repertoire of options to treat Afib and thats how to regard it. It may not be for you, maybe drugs do the trick for you etc....and that is great.
I'm really not sure what it is you want? Look the research up, have a read. If your unsure what the difference are betwen the variety of minimazes I suggest you book an appointment with a cardio thoracic surgeon of your choice whoever that maybe and discuss the surgery and your concerns with that person.
Saul is right Dr Wolfe made this massive step forward of moving the Maze open heart to keyhole maze. It is transformative. It required very different instruments, approaches and he developed them and Mr Hunter has been involved too. Operations often evolve over time. This op is no different. Eg the incisions made into the chest wall are tiny in comparison to what they used to be. It doesn't make it a different op, just one that has been refined. The refining will carry on....thank goodness for these brilliant inventive doctors.
I hope this helps. 🙂🙂
A question for members here as I'm fairly new to the board. Has anyone that has had the WMM or WO Procedure here shared negative results from either procedure?
Thx!
Recovery is different for everyone after the WOP or WMM. Much depends on your condition entering the procedure. Many have co-morbidities , diabetes, auto-immune disorders-thyroid issues- repeated previous catheter ablations- obesity, previous heart surgery’s, etc. some get off the OR table , walk home and go on with their lives. Some of us have slower recoveries. The mini maze is considered heart surgery even tho it is all done on the surface of the heart. The heart is never penetrated. People on our site share their recovery experiences good and those more challenging. Time and patience is needed to reach the finish line. Nothing is 100% and 5-7% will need a catheter ablation 6-12 months after for some rogue areas away from where the mini maze was done and all of these patients have done very well after. Dr Wolf and Dr Ohtsuka have never had a death or Phrenic nerve injury due to their procedure.
Thx for the reply! I'm asking because of being diagnosed with PA in Aug. last summer, and I've had one less than successful RF ablation although only 2 months out now from that, 3 cardioversions, having tried 4 different medications so far and being symptomatic with exhaustion, dizziness and headaches when in AFib. I was told on my last visit that choices remaining were try another med and if it doesn't work, a pacemaker which is unacceptable to me.
I would recommend joining the WolfMiniMaze Facebook page, read the posts and do your research to see if it is right for you. I had the WMM after reading about it here from Bambi who had just had it done. That was 18 months ago. I was not interested in catheter ablation and having my heart burned up. I have been AFib free since and on no meds. I would do it again with no hesitation. Best decision I have ever made.
I want to thank everyone for this frank discussion on the WMM. I learned a lot and it sound like the way to go. I'll continue my research as my appointment isn't until May. This site is great! Good luck to all you folks who have this crappy condition - but it is kinda fun belonging to an exclusive club!! 
This is a general note. I recently read the mini-maze is now offered at the University of Tennessee in the US also.
Doing some more research, I see it (with LAA resection) is offered at the University of Florida, Dept. of Surgery along with the Hybrid Approach also.
There's a lot to get your head round. You may decide to make appointments to discuss the options for your case with them and then give yourself time to reflect what who you want to go with. I found it all a bit technical for me....I've often thought I shouldve trained as an electrcian and then maybe I'd understand it better. 🤣😅
I also explored having the Wolf minimize, intrigued by the high success rate. What led me to choose the more conventional ablation was that I couldn’t find published studies corroborating the claimed success rate. The studies I saw, admittedly with limited searching, seemed to put the WMM success rate more in line with the conventional ablation. So I chose the latter, as it’s much less invasive. I’m 7 weeks post-procedure, so far so good.
A regular catheter ablation is definitely NOT "much less invasive" than the WMM.Far from it.
A regular catheter ablation, as you know, goes up through the groin, into the heart, punches through the septum of the heart, and burns the heart from the inside. It causes millions if micro- embolli that require the patient to remain on anticoagulants
The WOP/WMM is completely external to the heart, and does not cause the millions of micro-embolli created by a regular catheter ablation.
I had the Wolf minimaze October 19, 2022 .
I take no blood thinners and I have been AFIB free since surgery.
I drove from PA for this surgery and would do it again in a heartbeat!
I am in Tokyo currently having just had this procedure, performed by Dr Wolf's colleague surgeon, Dr Ohtsuka.If you want yo ask questions of a recent patient, I will happily answer anything you want to know, or you can join me and many other successful prior patients, and interested potential candidates, over on Facebook in the WMM group.
I had a mini maze 16 years ago 2007 as part of study group on how long this procedure lasts/cures. I was afib free for 10 years. Then afib came back. Opted for a "touch up ablation" after being on meds for a few years. So far, afib free for 4+ years, however, there is no guarantee that afib will not come back. The technique that was used back then, has been streamlined now. Also, at the time, my LAA was closed off. I am on a low dose aspirin and low dose Flecainide. I am a bit of a puzzle to the medical folks, as my AFIB was diagnosed at age 30. I am now 74. No one to this point has been able to determine the cause, other than a genetic flaw. If this comes back, I have no problem going for another "touch up" Nothing about this is 100% guarantee fix. You are in good hands if you decide to go in that direction.
Did you have any contact with Dr Wolf and his minimaze procedure, or was yours a different procedure and/or different surgeon?
I understand Dr Wolf's first minimaze occurred in 2003, but you will know more than me.
All information welcome.
Mine was done by Dr Puskas who was at Emory University in Atlanta . He studied Wolf’s technique at his Houston clinic. Puskas still does mini maze, he is now in NY. There are several surgeons around the country who do these now. If you are in Houston, you can’t do much better.
Me? No, if you read my Bio you will see I'm an Australian now living in UK ... sadly nowhere near Houston.
But thanks for sharing your minimaze details. You were very much a pioneer in your treatment. Much appreciated.
If I ever needed a surgical procedure, a minimaze would be my first choice, and if I passed the restrictive eligibility rules here in UK, I would need to select from the limited number of NHS surgeons in UK doing a similar procedure, or perhaps pay privately and journey to Dr Ohtsuka, an associate of Dr Wolf, in Tokyo, as saulger has done successfully.🤞
But thankfully, at the moment, my pAF doesn't demand this kind of attention.
bob
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