hi
My EP says did to my heart having an anatomical variant he was unable to do the ablation as he couldn’t get to the heart through the vein. He is now telling me my only option is open heart surgery. Sounds a bt drastic but has anyone had this procedure for AF. My af has gone from PAF to persistent and is really getting me down. Any advice would be greatly appreciated. In UK.
You would first want to see if your're candidate from minimally invasive heart surgery (mini maze) before going for true open heart (maze). Your ep may or may not be up-to-date on the options available for mini maze in the UK.
Dr. Steven, Hunter at SHEFFIELD, performs either a mini maze and/or hybrid for afib. Several of our members have had them, and a good resource would be MummyLuv who I just tagged and hopefully will respond.
Jim
The surgical route is where the ablation is done both outside and inside the heart and at only a very few UK centres, so far as I know (at least from reading here). It is called the "Cox maze IV surgical procedure" and you'll find plenty here and online if you search. From what I have read of the procedure, it can be done by open chest or by minimally invasive methods. Both are deemed safe, with the former being used where other heart issues exist, such as a need to replace a valve or insert a stent, and so on.
Steve
Steve, my understanding is the cox maze 4 is only done outside of the heart with an incision down the sternum where the patient is put on a heart-lung machine.
The minimally invasive, mini maze is also done on the outside of the heart, but no incision down the sternum and no heart lung machine. This would include the Wolff mini maze and the mini maze that saulger received in Japan by Dr. Ohtsuka.
The procedure that done both inside and outside of the heart is called a hybrid. Not exactly, but it's somewhat a combination of the mini maze and a catheter ablation. So again, no heart-lung machine here. This is the procedure that Dr. Steven Hunter has done for a number of people here.
I'm suggesting that the OP look into something a little less invasive then the cox 4, should he be a candidate. Either mini maze or hybrid.
I think I have this right, but hopefully MummyLuv who has been treated by Dr. Hunter, will join the discussion and confirm.
Jim
I am sure you are right. My knowledge is minimal and picked up here and there. I did think the maze could be carried out in the two ways I suggested. I couldn't recall what the hybrid one was called.
In looking more deeply, I came across the following, which gives a reasonably compendious account. I notice that the writer does say that the Maze IV can be done in both invasive and minimally invasive ways:
"Surgical Treatment of Atrial Fibrillation" by Navaratnarajah, Luthra and Ohri.
Reading that really does bring home the deep complexity of these procedures - safe as they are. It must be difficult to suffer AF so symptomatically as to need such a complex operation.
Steve
I would suggest that you ask for a referral to Mr Steven Hunter at Sheffield Northern General.
He performs a minimally invasive mini maze surgical ablation which is on the outside of the heart.
I had this procedure on 15th March and am now at home recovering.
I do not live locally to Sheffield, you can elect to be referred to any hospital on the NHS. Consultations can be done remotely, as mine were. My follow up tests will be done locally to me and sent to Mr Hunter ahead of the telephone consultation.
hi and thankyou for your reply. My EP tried to do the ablation via groin but said there was no route to where he had to go due to an anatomical variant with my heart. He also said there was a blockage in my right coronary artery that was stable and probably had been there for a long time so he said he wouldn’t touch it. Do you think the mini maze would work for me and is this a similar reason why you had it versus the ablation. I hope you are recovering well and I really do appreciate your advice x
I cannot say whether or not you would be suitable for a mini maze. It’s worth having that consultation to find out. As it is done on the outside of the heart, rather than through blood vessels inside the heart, this is well worth looking into for you.
I have always refused an ablation on the basis that I don’t tolerate medication including anticoagulants, which still need to be taken after ablation. As part of the mini maze is to clip off the left atrial appendage, which is where clots form when in AF, the need for anticoagulants no longer exists. The aim is to get me off all medication in 3-6 months post op.
As others have suggested a minimaze or hybrid minimaze would be worth investigating. My EP refused to refer me and my GP wouldn’t step on his toes, therefore I say Mr Hunter privately for the initial consultation then joined the nhs list to have a hybrid minimaze in Sheffield. I’m 10 months out now from my surgery with 3 short runs of AF 4days, 7hrs and 2hrs all infection driven, I was permanently in AFL before the surgery. It’s certainly worth exploring.
I’ve had 4 failed ablations and I’m due to have open heart surgery for my af. They’re not even going in through the side because the previous 4 ablations. I’m 44 and this has seriously affected my quality of life..,,,
Hi
I can't have ablation, cardioversion or Anti-arrhymn meds.
Have you been tried on meds?
I take CCB Calcium Channel Diltiazem 120mg AM
BB Beta Blocker Bisoprolol 2.5mg PM
No palpations, pain or heart flutters ever just sweating uncontrollably. AF makes me stop and rest while walking, or stairs or elevation. Not breathless. It feels like no energy.
123/69. 60s bpm Day. 47avg bpm Night
Control feels heaps better.
cheri jOY. 75. (NZ)
A dear friend of mine had this done some time ago and I think the only thing she grumbled about was the time it took to recover - her hubby was useless so I think it preyed on her mind that the housework wasn't getting done properly. One thing she got out of that was that he learned to cook during that time and became a really good cook and carried on cooking after that. He didn't get on with cleaning, and washing up though! 
Hi, I'm in the United States and had open heart surgery to repair two valves in August 2021. While inside my chest they also did a maze procedure. Other than an occasional pvc, have not had any afib since. Wishing you the best!
Hi Kevin
How bad was the open heart surgery ie pain, recovery time etc?
Hello, I had very little pain. They kept asking me my pain level and each time I would say one maybe two. My recovery time went well also. I was in the hospital for 5 days. Nine days after my surgery I walked one mile! Surgery was done at Mayo in Rochester Minnesota
As others have said, a version of the Wolf minimaze would also be my choice if I was suitable and it was available on NHS (it is available on NHS, but limited to critical situations like yours).
Now saulger had a similar minimaze in Japan with Dr Ohtsuka (trained by Dr Wolf) because this was his best/cheapest private option. His Posts and Replies about his recent experience are well worth the read ...
healthunlocked.com/user/sau...
Then the Wolf minimaze procedure can be researched in videos both on his own website ...
... and on the Houston Methodist DeBakey YouTube channel which includes Dr Wolf's monthly live AF videos during which watchers can ask personal questions.
You do have options. Good luck.
I had a surgical ablation by OHS but I was having a valve replacement so it made sense to do it at the same time and also to implant a left atrial appendage clip (Atriclip)
you’ve got some great replies from my fellow mini mazers. I would definitely ask for a referral from your GP to Mr Hunter in Sheffield to see if you can have the surgical ablation without open heart. It’s VERY unusual for open heart to be done just for AF, it is normally only if you are having other surgery at the time. google CEASE AF study this will give you some background on success rates of surgical ablation (it’s hybrid so both surgical and catheter at the same time but will give you direction).
Your option then is with Mr Hunter on NHS or Dr Otushka in Japan if paying privately. the approaches are slightly different. Dr Wolf in Houston is eye watering expensive for self pay but he does produce some great educational content I found so valuable as ozzybob says.
Should you progress with Mr Hunter then send me a PM and I’ll send you a link to a small Facebook group of us mini mazers in the Uk that you’d be welcome to join.
Hiya
I have arranged a video consultation today with Dr Hunter and sent him all my notes so thank you all for the info. The problem with my case is that I have an anomaly where as there ia no route from groin to atrium because I have a dilated azygos and a total occlusion of the right coronary artery and also signs there has been a small heart attack happened years ago that I was unaware of. This is why the standard ablation was aborted. Im just hoping the mini maze is possible as I really don't want to go down the route of full blown open heart surgery. What are your thoughts on this?
Hi Henry, the mini maze is done from the outside of the heart so the route to the groin is not relevant. I can’t speak to the heart attack, that’s a question for Mr Hunter, if was due to a blocked artery/vein/valve problem he also does stents via keyhole so you’ll have a good discussion with him about all your heart. Tell him Alison says hi 👋 I am fast approaching my 2 year anniversary of him giving me sinus rhythm back
Henry,
Can you please Post an update from your video consultation with Dr Hunter back here on the Forum, rather than in a PM. There are many here on the Forum interested in the Dr's work and hoping for a good outcome for you.
bob
To add to mjames1 comment, I also had the mimi maze, *external only* robot-assisted laparoscopic procedure in Tokyo from Dr Ohtsuka just 9 weeks ago today, and it was fantastic!My AFib episodes went from every other day to zero since the op. I am very happy that I went.
If you can raise the funds - currently 2.3 million Yen - I can only say that for me, it was worth it. The first night out of hospital in a comfy bed to lie down to sleep without my AFib starting as soon as I lay down was bliss!
I would suggest you consider it, especially if you are physically unable to have the procedure available in the UK.
The care in Tokyo was top notch, and the experience of Tokyo after the op was also amazing. 💝
I will happily give you more details if you want to follow up on this.
I am also 55 years old and from the UK originally. ( Now in Canada.)
Good luck.🌸
Hiya
What was the Uk price in comparison? I’m still not sure I am a candidate yet due to my anomaly ie dilated azygos and blocked right coronary artery etc but I would really hope I would be as I would be very frightened to undergo a full chest open procedure. How long was your stay in hospital?
I am not sure what you mean about in comparison.🤔 There is no procedure the same as I had in Tokyo in the UK, as far as I know. Mr Hunter's procedure is convergent. Cost of Dr Ohtsuka's procedure is 2.3 million Yen currently.
I was in hospital 3 days pre-op. 6 days post-op, and then had to stay another week for a check up and remove stitches before I flew home.
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