Response to Afibbers

I posted a response to a question about Mini maze procedures on the Afibbers forum.  http://www.afibbers.org/forum/list.php?9

Afibbers.org has a very negative view of the mini maze procedure, which significantly contrasts with the other american site, my afib experience https://myafibexperience.org/forums which is very positive.


Post

I live in the UK.  This year I was part of a clinical trial for treatment of Persistent AF.  CeaseAF, http://www.hra.nhs.uk/news/research-summaries/cease-af/

This is an international study, and the Sheffield cardiology unit is the only centre involved in the UK

The CEASE AF study will compare the results of a combined epicardial surgical plus endocardial catheter technique versus a standard endocardial catheter ablation technique for safety, efficacy and quality of life for patients with persistent or long-standing persistent Afib.”

This involved a mini maze procedure in April, using an Atri-clip to close the LAA followed by an RF catheter ablation a couple of weeks ago.

I was pleased to be selected for the trial; my waiting time was shortened and I believed that the mini maze was likely to have more of a chance of success than multiple catheter ablations.  The follow up RF ablation was also pre-planned to be within six months of the mini maze, so I would not have to wait for the first ablation to fail and then return to the waiting list.

Under normal circumstances, I travel extensively for work, teaching technical courses to adults.  However in 2017 my AF and particularly bisoprolol was affecting my concentration and ability to be on my feet for an entire day, so my duties were changed.  I was then working mainly from home, developing course material, new products and meeting with industry figures on future developments.  This is much less stressful than my usual job.

The mini maze took place in April; I had no complications, but the recovery was still difficult.  Three entry wounds in each side and two collapsed and re-inflated lungs left me feel literally like I had been hit by a truck.  I was dosed with morphine, followed by oxycodone, tramodol, codeine and finally paracetemol.  I had to stay for two nights in the hospital.  I think that this was the most miserable I had felt in my entire life.

At home, I was eventually able to walk around the block on day four and was able to walk up to up four miles by day fourteen.  On day seventeen, I went back to work on light duties; marking and development.  I felt much better than before the operation; I was generally in NSR and apart from a few small blips my heart was behaving.  I did think later that I came back to work a little too soon and should have taken an extra week due to the level of fatigue I was feeling.  Before the op I was extremely fit (an athletic life is what caused the AF in the first place); I hate to think of the impact on an elderly or infirm person.

After three months, the surgeon was very happy with his work; he saw nothing to worry about and scheduled the catheter ablation.  He was expecting only minor work to be required.

In October, six months after the mini maze, I went for the catheter ablation.  I had cleared my diary for the rest of that week and the two following weeks to ensure that I could be fully rested.

The procedure took 4½ hours; the EP discovered electrical reconnection on two of the pulmonary veins, so ablated these, performed a CTI line for Atrial Flutter and added a box lesion set on the posterior atrial wall.  Atrial flutter had never been mentioned to me, but I understand it can be caused by the minimaze.

I had no recovery problems, except for a slight bleed at the catheter site in the groin, which meant a further couple of hours laying down flat. I was able to leave hospital the next day.  I had no trouble walking and made the deliberate decision not to get back to exercise too quickly.  Within a week, I was feeling better than I had for the previous year and a half; I cancelled my last week of sick leave and returned to work earlier than planned.

I can’t make a conclusion based on just myself, but the mini maze (it is only minimally invasive when compared to open chest surgery) was a terrible experience and the catheter ablation was easy.  Hopefully in a few years the results from the CEASE-AF study will add to the data and help define the procedures that can give the best outcome, but unless the mini maze is shown to be streets ahead, I would not rush to recommend it to people.

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