minimaze.org

What does "minimaze" mean?

Minimaze refers to "mini" versions of the original Maze procedure, a surgical cure for atrial fibrillation developed by James Cox, MD. A history of the terms "minimaze", "mini-Maze", "mini Maze", "microwave minimaze" and Wolf MiniMaze" can be found on the "Curative Procedures" page.

The origin of minimaze.org

Catheter ablation of atrial fibrillation was first described in 1998, and in February of 1998, the first case in the Pacific Northwest was performed. It became the standard curative approach to atrial fibrillation. In early 2004, however, a new, serious complication (a "fistula" or hole between the left atrium and the esophagus) was reported by investigators in Michigan and Milan, including one fatality. Although there is no well-defined reporting system in place for complications from ablation, by May 2005, 25 cases of left atrium - esophageal fistula (23 of them fatal) were thought to have occurred. Electrophysiologists began to reassess the role of catheter ablation of AF, and more seriously consider other approaches to advanced care of AF, including surgery.

At the same time, the critical role of the nervous system for induction and maintenance of AF was becoming better understood and much more convincing. Epicardial bipolar radiofrequency ablation of the left atrium with removal of the ligament of Marshall and left atrial appendage (the "Wolf MiniMaze" technique) became an attractive option for ablation of AF for several reasons, in particular because of the low likelihood of damage to other structures such as the esophagus, and because elimination of ganglionated plexi (GPs; nerves thought to be responsible for AF in some) and elimination of conduction are easily and reliably proven. Other approaches also are available, including the totally endoscopic microwave minimaze ablation procedure that is even less invasive than the Wolf MiniMaze, but reports of difficulty obtaining full thickness heating of the atrium with microwave energy (due to the blood flowing in the atrium underneath the microwave source, which draws away the heat), and reports of damage to other structures, and the inability to prove conduction block and elimination of the GPs led some to believe that Wolf's procedure was a better approach.

The minimaze procedures may have some advantages over catheter ablation and other surgical methods. They appear to have a relatively high potential for success, as they may address both the nerve causes of AF and electrical isolation of the pulmonary veins. The potential for complications is present for any procedure, but many of the problems associated with both catheter and the full Cox Maze III procedure appear to be less likely. In late 2004, we performed the first such procedure in Oregon.

Minimaze.org was developed by James McClelland, MD, with the intention to:

• promote discussion about issues surrounding curative procedures for atrial fibrillation, with a goal of improved patient outcomes
• promote collaboration between surgeons and electrophysiologists in the management of atrial fibrillation
• provide a resource for patients seeking information about management options for their AF
• provide a resource for physicians interested in advanced options for their patients or for initiating a minimally invasive surgical program at their institution

Minimaze.org would like to acknowlege all of those who have commented on this site, or otherwise helped to edit and improve it, including our patients, staff, members of OC, SHMC, OHVI, and others.

The team approach to management of AF

Cardiology, electrophysiology, and surgical expertise are all required to best manage AF in the modern era. To that end, we have assembled the following team with members of Oregon Cardiology, Cardiovascular Surgery Associates, the Oregon Heart and Vascular Institute, and Sacred Heart Medical Center, Eugene, Oregon.

James McClelland, MD Dr. McClelland received his medical degree from the University of Connecticut and completed his residency in Internal Medicine at Temple University Hospital in 1986. He received his cardiology training at Oregon Health Sciences University, then completed a Research fellowship at Duke University in 1990. He joined the faculty at University of Oklahoma in 1990, becoming a tenured Associate Professor of Medicine in 1996. He joined Oregon Cardiology in 1997. Dr. McClelland has a special interest in advanced ablation techniques, including catheter ablation of atrial fibrillation and the minimally invasive surgical techniques for atrial fibrillation. In 2004, he underwent training by Dr. Wolf at University of Cincinnati for the Wolf MiniMaze procedure, and subsequent training at the Cardiac Arrhythmia Research Institute regarding electrophysiologic aspects of the procedure; he was subsequently involved in the first such procedure in the state. Dr. McClelland is board certified in Internal Medicine, Cardiovascular Diseases, and Clinical Electrophysiology. He is a member of the American College of Cardiology and the Heart Rhythm Society. He has been the co-chairman of the Northwest Electrophysiology Society since 1997, and was appointed the Director of Heart Rhythm Services of the Oregon Heart and Vascular Institute in 2004. A list of his publications can be retrieved here.	David Duke, MD Dr. Duke grew up in the Chicago area and received his medical degree at the Northwestern University Medical School in Chicago in 1982. He served his residency in general surgery at the University of Chicago Pritzker School of Medicine before serving as the administrative chief resident at the University of Illinois at Chicago College of Medicine for four years. He served his residency in cardiovascular surgery at the University of Wisconsin Hospital and Clinics at Madison, Wisconsin He practiced in Portland before joining Cardiovascular Surgery Associates in 1992. Dr. Duke has extensive experience in all aspects of cardiac surgery. He specializes in transmyocardial revascularization, arrhythmia surgery, and in off-pump procedures. Off-pump surgery lets surgeons operate without heart-lung bypass, while the heart continues to beat. In 2004, he underwent training by Dr. Wolf at University of Cincinnati for the Wolf MiniMaze procedure and perfomed the first one in the state. SInce then, he has perfomed more of these procedures than anyone in the Western United States. He is certified by the American Board of Surgery and by the American Board of Thoracic Surgery. He is also a member of the Society of Thoracic Surgeons, the American College of Surgeons and the American College of Cardiology, and is Executive Medical Director of the Oregon Heart and Vascular Institute.
Ramakota Reddy, MD Dr. Reddy received his medical degree from the University of Pennsylvania in 1990. He completed his Internal Medicine Residency at the Wilford Hall USAF Medical Center. He completed his Cardiology and Electrophysiology fellowship at the University of Washington. Dr. Reddy practiced Electrophysiology at Wright Patterson Air Force Base prior to joining Oregon Cardiology. Dr. Reddy is board certified in Internal Medicine, Cardiovascular Diseases and Clinical Cardiac Electrophysiology. He practices Electrophysiology.	Michele O'Connor Michele O’Connor is an RN CNOR, with 18 years of nursing experience. Her diversified nursing background includes a focus in surgery; management & education, curriculum development, pain management and quality improvement. While an adjunct faculty member at Bronson School of Nursing she maintained her clinical skills in the level 1 trauma center. At Sacred Heart Medical Center Michele was the Surgical Services Education Coordinator and worked for Anesthesia services as an RN Clinician, focusing on pain management. She is currently enrolled in Gonzaga University Nurse Practitioner Program and is a part of the Cardiovascular Surgery Team, in the role of Cardiovascular Surgery Coordinator.
Donna Cash Donna Cash received a Bachelors degree in Nursing in 1979 at the University of Northern Colorado and a Masters in Nursing in Critical Care in 1990 from the University of Washington. In 1994 she received her Nurse Practitioners certification from the University of Washington. She holds current certification as an Adult Nurse Practitioner, and as a Critical Care Nurse. She has advanced training in management of all arrhythmias, as well as pacemakers, internal defibrillators, and resynchronization devices.	Adrienne Davis Adrienne Davis is a certified medical assistant. She received her certificate of training from Lane Community College in 2004 and is nationally certified through American Association of Medical Assistants. Adrienne has been employed at Oregon Cardiology since June of 2004.