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Comparative Effectiveness Review of Hybrid Maze Procedure for Atrial Fibrillation

July 15, 2019

Health Problem: Atrial fibrillation (AF) is a supraventricular, accelerated heart rhythm characterized by uncoordinated atrial activation that leads to inefficient, irregular atrial contraction. According to 2010 data, approximately 2.7 to 6.1 million people in the United States have AF. In both men and women, AF is associated with a significantly increased risk of death, stroke, declining cognitive function, and development of dementia.

Technology Description: The hybrid maze (HM) procedure, also referred to as hybrid ablation or a convergent procedure, combines 2 minimally invasive procedures, surgical ablation (SA) and catheter ablation (CA), for treatment of AF. SA involves an epicardial approach whereas CA involves an endocardial approach. The endocardial and epicardial ablative procedures can be performed simultaneously or as a staged procedure. HM is touted to provide the benefits of full penetration of the cardiac tissue, which increases the likelihood that ablation lines are transmural.

Controversy: Few studies compared HM with other minimally invasive surgical procedures until approximately 5 years ago. However, a number of recent studies have compared HM with SA or CA, and an evaluation of the comparative effectiveness and safety of this procedure is now possible. In addition, there is no standardized approach to the HM procedure. Variations exist with regard to the surgical approach, energy source used, lesion patterns, and timing of SA and CA procedures (simultaneous or staged).

Key Questions:

  • Does the HM procedure increase the rate of freedom from atrial arrhythmia (AA), prevent the recurrence of AA, and reduce the need for repeat intervention compared with alternative procedures (i.e., CA, SA, Cox maze [CM]) in patients with AF?
  • Is the HM procedure safe compared with alternative procedures (i.e., CA, SA, CM) for treatment of patients with AF?
  • Have definitive patient selection criteria been established for the use of the HM procedure?