Initial experiences of surgical left atrial maze through resected left atrial appendage

Despite high-level evidence support, the full Maze procedure remains underused because of complexity, prolonged arrest time, and training gaps. Therefore, we aimed to develop a simplified left atrial Maze procedure through the left atrial appendage.

All patients with permanent atrial fibrillation treated using this technique between January 2024 and February 2025 were enrolled. The technique comprised (1) bilateral pulmonary vein isolation, (2) appendage-to-roof ablation, (3) appendage ridge ablation, (4) mitral annulus ablation, (5) endocardial bottom line ablation, (6) epicardial bottom line ablation, and (7) inferior vena cava and tricuspid line ablation. Left atrial Maze was performed through an amputated left atrial appendage. All ablation lines were created using the AtricureRF (AtriCure, Inc., Cincinnati, Ohio, United States) and CryoICE (AtriCure, Inc., Cincinnati, Ohio, United States) devices.

Among 17 patients, six and 11 underwent aortic valve surgery and coronary bypass grafting, respectively. Atrial fibrillation was classified as long-standing in 13 patients and persistent in four. Surgical ablation through the left atrial appendage was completed within 20 min of cardiac arrest. Overall survival and freedom from recurrent atrial fibrillation at 12-month follow-up were 94% and 86%, respectively. During follow-up, no patient required pacemaker implantation owing to new-onset complete atrioventricular block, and survivors had New York Heart Association Class I status.

This technique is safe, simple, and provides acceptable freedom from recurrent atrial fibrillation, promising optimal survival. It can be perform with shorter cardiac arrest time and fewer complications and recommended as a concomitant procedure regardless of left atriotomy.