It may be time to ablate. Options are in play.

After my a-fib diagnosis four years ago and subsequent treatment with dofetilide, my relapses requiring cardioversion have gone from two years to six months, to five, to three then one. I have identified most of my triggers but it is clear things are deteriorating in spite of my best efforts.
My EP says it may be time for my first ablation. Unfortunately, the local facility performing ablations is unavailable for three months. Hence my interest in alternative locations/treatment.
I contacted the Cardiac Arrhythmia Institute for a consultation with Dr. Natale's group.
My investigation into the Wolfe mini-maze as an alternative is still the early stages.
I would be interested in information regarding a comparison between the internal ablation vs mini-maze as performed by the physicians/groups considered the "gold standard" based on reports on this forum. I am particularly interested in recent procedures and of course long term results.
Thanks. Doc.

The MAZE procedure, as I understand it, is much more invasive, and probably requires a hospital stay. This adds levels of cost. Catheter ablation, while enjoying a modest success rate (about 75-80% for the heavy majority of practitioners and their patients for a first, or index, ablation, seems to hold out well if the blanking period passes without any further arrythmia in the last three/four weeks. I have no other information about MAZE, and have not done any reading as I was interested in something quick, less involved, and with a modicum of success behind it. Catheter ablation is day surgery. Most are being driven back home within about six hours of the procedure.

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docboss
Unfortunately, the local facility performing ablations is unavailable for three months. Hence my interest in alternative locations/treatment.
I contacted the Cardiac Arrhythmia Institute for a consultation with Dr. Natale's group.

Unfortunately the best EPs performing ablations will have significant wait times--in fact, if they don't you probably don't want to go to them. Natale (you would want to consult with Natale himself, rather than one of his group) will also have several months wait time though his list is prioritized according to urgency. His success rate is well above the statistics you will read for catheter ablations and, as you will have read, recovery from an internal ablation is really minimal whereas from a mini-maze it will be much longer. There is also an added risk of subsequent atrial flutter after maze procedures. It is good do what you are doing--gathering information and opinions from different practitioners--before making your decision but there is good evidence that going ahead with a procedure will be a better choice than continuing with antiarrhythmics.

I met with Dr. Randall Wolf to discuss my options but for me his mini-maze seemed too invasive at my stage although he said he could offer me one if I wanted. i contacted offices of both Dr. Wolf and Dr. Natale in December. I had my first appointment with Dr.Natale January 29, and Dr. wolf the middle of Feb. I had pulse field with Dr. Natale on April 9 and so I didn't have to wait long and I certainly was not an urgent case by any means, but living within driving distance probably helped. Dr. Wolf has a facebook page for past and future patients, which you can join. So I am now two weeks out from my ablation with Dr.Natale. I am not springing to life although I did run a mile on day 8, 10 and 11, and cross fitted three times. However I have some inflammation in my pleura cavities but not bad, but have been placed on a med for a couple of weeks. I think this is not uncommon especially with 'younger' patients and those with a lower chadsvasc score from what I have read. let me know if I can help answer anything else?

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Daisy
There is also the added risk of subsequent risk if added atrisl flutter after (Mini) Maze .

As part of the healing period, about 10% of Dr. Wolf's patients develop a single flutter episode which is resolved by cardioversion with no further ablation needed.
Keep in mind that repeated catheter ablations can leave you with atypical flutter that could require another ablation. There are pros and cons to the Wolff mini maze (WMM) but developing chronic flutter is not one of them.

Jim

I had mini maze 16 years ago as part of a study and was afib free for 10 years. Then afib came back. I am sharing this because the mini maze does not guarantee a complete cure. You may have to have a "touch up" or two over the years. I had one 5 years ago. Still on low dose medication to maintain rhythm because I had AFIB for many years. (over 40 years at this point) I was diagnosed when I was 30 years old - rare back then..

May need another "touch up" in the future. I did have a hospital stay for 3 days back then. The technique has been improved and I understand the hospital stay is shorter. Some centers do a hybrid approach now, the mini maze and the traditional ablation.

Thanks for the information. I am scheduled for a cardioversion locally next week. We have family in Austin so travel is irrelevant if I desire to choose to pursue the Texas Arrhythmia Institute path. An acquaintance in Austin had an ablation and Watchman recently by Dr. Burkhardt at the Institute and was please with the procedure/protocol. Obviously it is far too soon to judge the results.
Does anyone have any experience Dr. B?
I like my local EP but have not yet decided if I wish to start down the road of multiple ablations. There are so many stories, some of which are horrific, of failures and worse. This is why I am exploring the mini-maze option. Although the mini-maze is more invasive with extended recovery, the thought of multiple catheter ablations hanging over me like a "sword of Damocles" is frightening. It appears you pay early with a mini-maze or perhaps later with the ablation(s). I guess this is what I get with a family history of arrhythmia, 20 years of competitive cycling, and 10 years of body building.
I understand Dr. Natale is very desirable but also extraordinarily busy.
No response to my inquiry as of this date, but I shall make another attempt in a week or so.
Thanks again for the great information and please keep it coming. I am sure there are plenty of "afibbers" facing the same dilemma as I.
Be safe, Doc.

Burkhardt is good but Natale is better. I would readily wait a month or two longer for Natale.

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docboss
No response to my inquiry as of this date, but I shall make another attempt in a week or so.

You will get a response much faster if you go directly to Dr. Natale's assistant:
Norma Bazerghi RN, MSN, MBA
Single Trip Procedure Coordinator for Andrea Natale M.D.
Direct Line: 512-615-6205
Fax: 512-776-1978 Attn: Norma

If you would like her email address, send me a private message as email addresses get picked up by the bots that are scanning the forum.

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docboss
. It appears you pay early with a mini-maze or perhaps later with the ablation(s)

Well put!

You owe it to yourself to at least have a consult with Dr. Wolf, which can be done over video chat if you don't want to travel to Houston.. You should also check out the Wolf mini maze(WMM) Facebook Group if you haven't already.

Jim