Video-Assisted Thoracoscopic Surgery Maze procedure

Surgical treatment for AF

There are two types of surgical treatment for AF.

Open technique

The open technique is performed with a median sternotomy: a 25-to-30-cm vertical inline incision along the sternum, after which the sternum itself is divided and the patient is connected to a heart-lung machine. Several incisions are made in the atria to block the abnormal electrical circuits to obtain a normal sinus rhythm. This surgery is also referred to as the ‘cut-and-sew’ or ‘Cox maze’ procedure.
The circuits can also be blocked using alternative energy sources such as radio frequency, microwave and cryothermia. This “maze” procedure is usually performed in conjunction with other procedures on the heart such as mitral valve surgery and bypass surgery.

Minimally invasive AF ablation

The basic principles of the Cox maze procedure (see above) can also be obtained in a minimally invasive way. This means without opening the chest. This way of surgery is based on the VATS technique during which a thoracoscope with a video camera is inserted through some small incisions (ports). The ablation instruments used for the surgery are inserted through the other ports and the abnormal electrical circuits are blocked in the atria. This procedure is also referred to as a mini-maze.


The results of AF surgical treatment are very good and lead to a return to sinus rhythm up to 90%. Because of that, antiarrhythmic medication and blood thinners are no longer required.

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