Hybrid Maze 

Cardiac specialists at SSM Health Saint Louis University Hospital are performing a new minimally-invasive “Hybrid” approach to treating atrial fibrillation (AFIB) that combines surgery and catheter-based techniques to put a patient’s heart back into proper rhythm.

Called Hybrid Maze, the procedure is performed in two stages. In the first stage, surgeons create a “maze” or scar on a beating heart without opening a patient’s chest and in the second stage, cardiac electrophysiologists perform catheter ablation to create more scars inside the heart. This cures a patient’s AFIB by putting it back into rhythm, all without a sternotomy and offering quicker recovery.

“With Hybrid Maze we combine minimally-invasive surgery with catheter based techniques to offer patients better outcomes and improved recovery time,” says Richard Lee, MD, SLUCare cardiac surgeon and co-director of the Center for Comprehensive Cardiovascular Care (C4) at Saint Louis University Hospital.

“We can recreate all the lesions of the Maze that formally needed an open incision down the chest,” says Dr. Lee, who performs the procedure in tandem with SLUCare electrophysiologist Ali Mehdirad, MD.

More than six million Americans suffer from atrial fibrillation, a type of heart arrhythmia where the upper chambers (atria) of the heart beat irregularly and rapidly. This irregular atrial beat causes the impulses to pass irregularly to the ventricle (lower chambers), which results in inefficient pumping, reduced blood output, and often low blood pressure with symptoms of dizziness or shortness of breath.

The primary surgical procedure for AFIB is called Maze. “Maze creates scar in different areas of the heart that directs the impulse wave of electricity through the maze of scar from the upper chamber to the lower chamber,” says Dr. Lee. “Historically, the way to do that was to open someone’s chest and cut and sew to make all the lesions.”

With Hybrid Maze, the procedure is a bit different.

“I actually do a minimally invasive procedure on half the scars on the outside of the heart and Dr. Mehidrad will create the remainder of the scars inside the heart via a catheter in the groin,” says Dr. Lee. “Together, we can create all the lesions of the maze procedure that previously needed an open heart surgery.”

Like any heart procedure, Dr. Lee’s half of hybrid maze still includes an invasive thoracoscopy of the chest while under anesthesia. However, he is able to perform the thoracoscopy through three tiny incisions rather than opening up the breastbone.

Dr. Lee says that’s why hybrid maze patients still stay in the hospital for a few days like their open surgery counterparts, but they have fewer restrictions. “If you undergo traditional cardiac surgery where you divide the breastbone, it really takes about two months for patients to feel normal and be able to lift things,” says Dr. Lee. “With hybrid maze, patients can go back to lifting within a few days.”