epicardial maze with testing.mp4 (503.66 MB)

Non Atriotomy Epicardial Ablation for AF

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posted on 2021-05-14, 14:24 authored by Eric Okum

This video demonstrates a novel non-atriotomy technique for performing the maze procedure in patients undergoing non mitral valve open heart surgery. It is estimated that only 15-25% of patients with atrial fibrillation undergoing either coronary artery bypass or aortic valve procedures receive a maze procedure(1). However, concomitant maze procedure is recommended by the Society of Thoracic Surgeons guidelines as a Class I indication for those undergoing CABG, AVR , or combination of both(2).
This video shows step by step instructions for performing an epicardial maze with a combination of radiofrequency ablation and cryo. Intraoperative testing of the pulmonary veins and posterior wall of the left atrium provides information for entrance and exit block, enhancing the robust nature of the lesion set. This technique is simple, safe, effective, and reproducible. The entire lesion set adds approximately twenty minutes of bypass time and five to ten minutes of cross clamp time.


1. Ad N, Holmes SD, Rongione AJ, Badhwar V, Wei L, Fornaresio LM, Massimiano PS. The long-term safety and efficacy of concomitant Cox maze procedures for atrial fibrillation in patients without mitral valve disease.
.J Thorac Cardiovasc Surg. 2019 Apr;157(4):1505-1514. doi: 10.1016/j.jtcvs.2018.09.131. Epub 2018 Nov 22.
2. Badhwar V, Rankin JS, Damiano RJ Jr, Gillinov AM, Bakaeen FG, Edgerton JR, Philpott JM, McCarthy PM, Bolling SF, Roberts HG, Thourani VH, Suri RM, Shemin RJ, Firestone S, Ad N. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg. 2017 Jan;103(1):329-341. doi: 10.1016/j.athoracsur.2016.10.076. PMID: 28007240.


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