New Minimally Invasive Atrial Fibrillation Surgery First Cases in the World Performed at University Hospital by Dr. Randall K. Wolf

Randall K. Wolf, MD, cardiothoracic surgeon with the University of Cincinnati (UC) Department of Surgery, recently debuted a new procedure called the "minimaze", for the surgical treatment of atrial fibrillation (AF). After extensive research and efforts spanning 5 years, Dr. Wolf developed this new minimally invasive minimaze procedure to cure AF without making a large incision in the patient’s chest and without using the heart-lung machine.

AF is widely known as the most common sustained cardiac arrhythmia affecting an estimated 2.5 million patients in the U.S. There are approximately 300,000 new cases per year diagnosed. It is predicted that 5.6 million patients will be diagnosed with AF by the year 2050. The risk of stroke in patients with AF is estimated at 7 times greater than patients without AF. AF is second only to heart failure in terms of cardiac related hospitalizations.

Dr. Wolf performed the first two cases using the “Minimaze” technique at The University Hospital, Cincinnati, OH in August 2003. This procedure and technology are designed to treat atrial fibrillation in patients who have chronic intermittent AF and are non-responsive or not tolerant to drug therapy. These were the first patients in the world treated without a full sternotomy (surgical opening of the sternum). The technology used in bipolar radiofrequency (RF) ablation and electrical isolation of the pulmonary veins. Dr. Wolf used Atricure’s (West Chester, OH) ISOLATOR clamp which generates bipolar RF to ablate or cut specific cardiac structures necessary for maintenance of AF.

The ablation procedure was performed through two small “mini-thoracotomies,” or small incisions, one on each side of the chest. This is accomplished without spreading the patient’s ribs. During the procedure, the left atrial appendage, a suspected major source of cardioembolic stroke in AF patients, was also removed.

Surgical ablation devices have been used world-wide in thousands of patients to cure AF in a less invasive procedure. "Cut-and-sew" MAZE is a drastic surgery also referred to as the "Cox-Maze" procedure, where the upper chambers of the heart are cut and then sewn back together to create a maze of scar tissue to block the electrical signals causing AF. The "Cox-Maze" procedure is not performed often because it is an open-heart surgery that requires the use of a heart-lung machines and is costly, complex and traumatic. However, until now its use has been solely for patients with AF who were undergoing major heart surgery for other cardiac diseases. The minimaze procedures performed at UC were specifically focused on treating AF as a standalone condition.

The new, less invasive minimaze procedure allows patients who have suffered from long-standing intermittent AF to undergo a less invasive surgery to treat their AF and recover faster than traditional surgery. Patients who undergo theminimaze procedure are expected to have minimum hospital stays of 2-3 days, compared to 7 or more with conventional surgery.

“I have been evolving the minimaze technology and technique for the past four years, and am very optimistic and excited about initiating this technique for patients at The University Hospital. It gives us a curative treatment for atrial fibrillation without conventional heart surgery and without the heart-lung machine.” Dr. Randall K. Wolf, director of University of Cincinnati's Center for Surgical Innovation.

Dr. Wolf serves as a cardiothoracic surgeon at the University of Cincinnati. He is also the director of the University of Cincinnati’s Center for Surgical Innovation (CSI).