Hybrid Cardiac Ablation & Minimally Invasive Cox Maze Procedure

If you have atrial fibrillation, also called AF, your doctor may discuss several treatment options with you. These options may include surgery. Advanced surgical options include hybrid surgical-catheter ablation and minimally invasive Cox Maze procedure.

• In atrial fibrillation, also called AF, abnormal electrical signals cause the upper chambers of the heart to quiver instead of beating normally. AF is serious and requires treatment.
• increases the risk of stroke significantly, requiring patients to take blood thinners for the long term.
• can cause heart failure because it interferes with the heart’s efficiency as a pump, forcing it to work harder. The heart can become enlarged as a result.
• is, like high blood pressure, a general health risk.

AF patients who don’t respond well to medication often require cardiac ablation, a class of procedures that strategically creates lines of scar tissue to block transmission of the abnormal electrical signals that underlie atrial fibrillation. Cardiologists generally direct their AF patients to catheter-based ablations. However, patients with non-paroxysmal (persistent) or chronic AF often require multiple procedures, and the abnormal rhythm frequently comes back.

At Stanford, we offer atrial fibrillation patients comprehensive options focused on minimally invasive approaches that provide more durable results than catheter ablation alone.

Patients whose AF is persistent or long-standing may therefore require surgical ablation. The Cox Maze procedure has long been considered the "gold standard" treatment, but it is an open-heart surgery that calls for cardiopulmonary bypass.

For patients who already require open-heart surgery, we can perform a Cox Maze procedure at the same time. Patients who aren’t already planning open-heart surgery can opt for either a Cox Maze or a hybrid ablation.
At Stanford, we often perform the Cox Maze procedure with a minimally invasive, 5-centimeter anterior thoracotomy incision.

Hybrid ablation offers an even less invasive alternative for eligible patients. Hybrid ablation combines catheter ablation with a minimally invasive surgical ablation for the best care short of Cox Maze surgery. We perform surgical ablation on the outside of the heart through a video-assisted thoracoscopic (VATS) technique. There’s no need to spread the patient’s ribs with this technique, reducing pain and speeding healing. We combine this with a catheter ablation, which targets the inside of the heart. Early results suggest this combination is nearly as effective as the open heart Cox Maze procedure.

For patients who require or prefer the Cox Maze procedure, Stanford is a leading provider. We can often use a minimally invasive approach, with a 5-centimeter incision rather than a median sternotomy.