{"schema_version":"bookimed.page-context.v1","id":"heart-rhythm-surgery","url":"https://hub.bookimed.com/heart-surgery/heart-rhythm-surgery/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-rhythm-surgery.json","index_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/index.json","full_dataset_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/content.json","content_revision":"source-driven-rankings-20261008","date_modified":"2026-10-08","language":"en","kind":"guide","title":"Atrial fibrillation surgery: Maze, ablation and appendage closure","summary":"Rhythm surgery and stroke-prevention procedures have different purposes. Maze or surgical ablation targets abnormal electrical pathways; left-atrial-appendage closure targets a source of blood clots.","research_credit":{"name":"Yevhenii Kozlov","role":"Co-Founder of Bookimed","url":"https://us-uk.bookimed.com/ceo/kozlov/","contribution":"Research personally prepared and reviewed","assistance":"AI tools assisted source research."},"editorial_scope":"Source-based patient information; an individual treatment plan requires clinical review.","research_method":"How this guide is researched and compared Research project led by Yevhenii Kozlov . We link clinical guidance, primary studies and named hospital or offer sources beside the relevant statements. Comparisons distinguish individual operators from programme results and preserve the study population, follow-up and limitations. Prices are dated examples with their stated scope. Research and editorial preparation are separate from clinical review; no named clinician has medically reviewed this edition. Bookimed provides care coordination. Partner and reference programmes are identified from their sources; paid ordering is not used in our published-cohort comparison. Read the editorial policy .","key_takeaways":[{"label":"Combined treatment can be relevant","text":"AF may be treated during another planned cardiac operation rather than requiring a separate open-heart operation.","sources":["C17"]},{"label":"Appendage closure adds stroke protection","text":"LAAOS III found benefit in patients with AF and elevated stroke risk already having cardiac surgery, on top of usual care including anticoagulation.","sources":["C18"]},{"label":"A pacemaker has a different job","text":"Rate support or protection against dangerous rhythms is distinct from ablation or appendage closure.","sources":["D01"]}],"benefits":[{"text":"An already planned operation can provide an opportunity to address AF and stroke risk in the same treatment course.","sources":["C17","C18"]}],"limitations":[{"text":"Appendage closure does not automatically replace blood thinners, and freedom from AF depends on the rhythm type, treatment and monitoring used.","sources":["C18"]}],"sections":[{"id":"benefit-balance","title":"Benefits and trade-offs","text":"Benefits and trade-offs Potential advantages An already planned operation can provide an opportunity to address AF and stroke risk in the same treatment course. Sources: STS: AF during cardiac surgery · LAAOS III trial · ACC Trade-offs and limits Appendage closure does not automatically replace blood thinners, and freedom from AF depends on the rhythm type, treatment and monitoring used. Sources: LAAOS III trial · ACC","links":[{"label":"STS: AF during cardiac surgery","url":"https://www.sts.org/sites/default/files/Database%20Webinar%20Handouts/ACSD%20Monthly%20Webinar%2005062026.pdf"},{"label":"LAAOS III trial · ACC","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III"},{"label":"LAAOS III trial · ACC","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III"}]},{"id":"options","title":"Name the goal of each procedure","text":"Name the goal of each procedure Treatment Main purpose Medicines or catheter ablation Control symptoms, heart rate or rhythm according to the arrhythmia Surgical ablation / Maze Interrupt abnormal electrical pathways, sometimes during another planned cardiac operation Left-atrial-appendage closure Reduce a source of clot-related stroke risk in selected patients Pacemaker / ICD Treat separate slow-rate or dangerous-rhythm needs Sources: Conditions treated by heart surgery · STS: AF during cardiac surgery · LAAOS III trial · ACC","links":[{"label":"Conditions treated by heart surgery","url":"https://www.nhlbi.nih.gov/health/heart-surgery/conditions"},{"label":"STS: AF during cardiac surgery","url":"https://www.sts.org/sites/default/files/Database%20Webinar%20Handouts/ACSD%20Monthly%20Webinar%2005062026.pdf"},{"label":"LAAOS III trial · ACC","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III"}],"tables":[[["Treatment","Main purpose"],["Medicines or catheter ablation","Control symptoms, heart rate or rhythm according to the arrhythmia"],["Surgical ablation / Maze","Interrupt abnormal electrical pathways, sometimes during another planned cardiac operation"],["Left-atrial-appendage closure","Reduce a source of clot-related stroke risk in selected patients"],["Pacemaker / ICD","Treat separate slow-rate or dangerous-rhythm needs"]]]},{"id":"combined","title":"If you already need valve surgery or bypass","text":"If you already need valve surgery or bypass STS guidance addresses surgical ablation and appendage management in patients with AF undergoing first-time nonemergency cardiac surgery. Raise this before the operation so the team can explain the combined plan. Sources: STS: AF during cardiac surgery Heart valves ↗ Coronary bypass ↗","links":[{"label":"STS: AF during cardiac surgery","url":"https://www.sts.org/sites/default/files/Database%20Webinar%20Handouts/ACSD%20Monthly%20Webinar%2005062026.pdf"},{"label":"Heart valves ↗","url":"https://hub.bookimed.com/heart-surgery/heart-valve-surgery/"},{"label":"Coronary bypass ↗","url":"https://hub.bookimed.com/heart-surgery/coronary-bypass/"}]},{"id":"anticoagulation","title":"Appendage closure does not automatically replace anticoagulation","text":"Appendage closure does not automatically replace anticoagulation LAAOS III studied patients with AF and elevated stroke risk already undergoing cardiac surgery. Appendage occlusion reduced stroke or systemic embolism on a background of usual care including anticoagulation. The study does not justify stopping blood thinners because the appendage was closed. Sources: LAAOS III trial · ACC","links":[{"label":"LAAOS III trial · ACC","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III"}]},{"id":"results","title":"Rhythm control and stroke protection measure different benefits","text":"Rhythm control and stroke protection measure different benefits Freedom from AF, freedom from rhythm medicines and avoidance of stroke are distinct outcomes. Rhythm monitoring and follow-up duration determine what a reported result can show. A normal rhythm at discharge does not establish durable freedom from AF. Appendage closure in LAAOS III added to usual care, including anticoagulation. Permanent pacing and other complications remain relevant to the overall result. Sources: STS: AF during cardiac surgery · LAAOS III trial · ACC","links":[{"label":"STS: AF during cardiac surgery","url":"https://www.sts.org/sites/default/files/Database%20Webinar%20Handouts/ACSD%20Monthly%20Webinar%2005062026.pdf"},{"label":"LAAOS III trial · ACC","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III"}]},{"id":"records","title":"The information that defines rhythm treatment","text":"The information that defines rhythm treatment The rhythm diagnosis and monitoring show the pattern and duration of the arrhythmia. Earlier ablations and current medicines show what treatment has already been tried. An associated cardiac operation changes whether surgical ablation can be combined with other care.","links":[]},{"id":"matching-specialists","title":"Specialists for this treatment pathway","text":"Specialists for this treatment pathway Explore each specialist’s clinical focus, current programme and the studies relevant to this treatment. The listed roles include cardiac surgeons and, where appropriate, interventional cardiologists. Portrait source ↗ Cleveland, Ohio · United States cardiac surgeon A. Marc Gillinov → Gillinov’s practice combines surgical atrial-fibrillation treatment and mitral repair, relevant when AF and valve leakage coexist. Cleveland Clinic → Sources: A. Marc Gillinov, MD | Cleveland Clinic View expertise and research → Portrait source ↗ Chicago · United States cardiac surgeon Husam H. Balkhy → Balkhy’s UChicago practice includes robotic surgery for atrial fibrillation. UChicago Medicine → Sources: Husam H. Balkhy, MD View expertise and research → AJ St. Louis, Missouri · United States cardiac surgeon Ali J. Khiabani → Khiabani’s current WashU profile includes minimally invasive AF surgery and valve surgery. WashU Medicine / Barnes-Jewish Hospital → Sources: Ali J. Khiabani, MD, MHA — physician profile · The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation. View expertise and research → Browse the full specialist directory →","links":[{"label":"Portrait source ↗","url":"https://providers.clevelandclinic.org/provider/a-marc-gillinov/4268438"},{"label":"A. Marc Gillinov →","url":"https://hub.bookimed.com/heart-surgery/doctor-marc-gillinov/"},{"label":"Cleveland Clinic →","url":"https://hub.bookimed.com/heart-surgery/clinic-cleveland/"},{"label":"A. Marc Gillinov, MD | Cleveland Clinic","url":"https://providers.clevelandclinic.org/provider/a-marc-gillinov/4268438"},{"label":"View expertise and research →","url":"https://hub.bookimed.com/heart-surgery/doctor-marc-gillinov/"},{"label":"Portrait source ↗","url":"https://www.uchicagomedicine.org/find-a-physician/physician/husam-h-balkhy"},{"label":"Husam H. Balkhy →","url":"https://hub.bookimed.com/heart-surgery/doctor-husam-balkhy/"},{"label":"UChicago Medicine →","url":"https://hub.bookimed.com/heart-surgery/clinic-uchicago/"},{"label":"Husam H. Balkhy, MD","url":"https://www.uchicagomedicine.org/find-a-physician/physician/husam-h-balkhy"},{"label":"View expertise and research →","url":"https://hub.bookimed.com/heart-surgery/doctor-husam-balkhy/"},{"label":"Ali J. Khiabani →","url":"https://hub.bookimed.com/heart-surgery/doctor-ali-khiabani/"},{"label":"WashU Medicine / Barnes-Jewish Hospital →","url":"https://hub.bookimed.com/heart-surgery/clinic-washu-barnes-jewish/"},{"label":"Ali J. Khiabani, MD, MHA — physician profile","url":"https://physicians.wustl.edu/people/ali-j-khiabani-md-mha/"},{"label":"The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation.","url":"https://pubmed.ncbi.nlm.nih.gov/32563577/"},{"label":"View expertise and research →","url":"https://hub.bookimed.com/heart-surgery/doctor-ali-khiabani/"},{"label":"Browse the full specialist directory →","url":"https://hub.bookimed.com/heart-surgery/heart-rhythm-surgery-surgeons/"}]}],"introduction":"Heart surgery guide / Rhythm & Maze surgery Rhythm & Maze surgery · Decision guide Atrial fibrillation surgery: Maze, ablation and appendage closure Understand rhythm treatment during another heart operation and why stroke prevention is a separate question. Research by Yevhenii Kozlov · Co-Founder of Bookimed Updated 8 October 2026 Sources linked throughout At a glance Rhythm surgery and stroke-prevention procedures have different purposes. Maze or surgical ablation targets abnormal electrical pathways; left-atrial-appendage closure targets a source of blood clots. Combined treatment can be relevant AF may be treated during another planned cardiac operation rather than requiring a separate open-heart operation. Sources: STS: AF during cardiac surgery Appendage closure adds stroke protection LAAOS III found benefit in patients with AF and elevated stroke risk already having cardiac surgery, on top of usual care including anticoagulation. Sources: LAAOS III trial · ACC A pacemaker has a different job Rate support or protection against dangerous rhythms is distinct from ablation or appendage closure. Sources: Conditions treated by heart surgery","related_documents":[{"id":"heart-surgery","title":"Heart surgery abroad: treatments, clinics and costs","kind":"home","url":"https://hub.bookimed.com/heart-surgery/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-surgery.json"},{"id":"coronary-bypass","title":"Coronary bypass surgery (CABG): options, teams and recovery","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/coronary-bypass/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/coronary-bypass.json"},{"id":"heart-valve-surgery","title":"Heart valve surgery: repair, replacement and catheter options","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/heart-valve-surgery/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-valve-surgery.json"},{"id":"second-opinion","title":"Prepare for a heart surgery second opinion","kind":"inquiry","url":"https://hub.bookimed.com/heart-surgery/second-opinion/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/second-opinion.json"},{"id":"conditions","title":"Heart conditions: find your diagnosis and treatment guide","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/conditions/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/conditions.json"},{"id":"doctor-marc-gillinov","title":"A. Marc Gillinov: Mitral repair specialist","kind":"doctor-profile","url":"https://hub.bookimed.com/heart-surgery/doctor-marc-gillinov/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/doctor-marc-gillinov.json"},{"id":"doctor-husam-balkhy","title":"Husam H. Balkhy: robotic coronary bypass surgery","kind":"doctor-profile","url":"https://hub.bookimed.com/heart-surgery/doctor-husam-balkhy/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/doctor-husam-balkhy.json"},{"id":"doctor-ali-khiabani","title":"Ali J. Khiabani: Maze and surgical atrial fibrillation treatment","kind":"doctor-profile","url":"https://hub.bookimed.com/heart-surgery/doctor-ali-khiabani/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/doctor-ali-khiabani.json"},{"id":"clinic-cleveland","title":"Cleveland Clinic: heart surgery expertise","kind":"clinic-profile","url":"https://hub.bookimed.com/heart-surgery/clinic-cleveland/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/clinic-cleveland.json"},{"id":"clinic-uchicago","title":"UChicago Medicine: heart surgery expertise","kind":"clinic-profile","url":"https://hub.bookimed.com/heart-surgery/clinic-uchicago/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/clinic-uchicago.json"},{"id":"clinic-washu-barnes-jewish","title":"WashU Medicine / Barnes-Jewish Hospital: heart surgery expertise","kind":"clinic-profile","url":"https://hub.bookimed.com/heart-surgery/clinic-washu-barnes-jewish/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/clinic-washu-barnes-jewish.json"},{"id":"heart-rhythm-surgery-surgeons","title":"Heart rhythm surgery specialists","kind":"specialist-directory","url":"https://hub.bookimed.com/heart-surgery/heart-rhythm-surgery-surgeons/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-rhythm-surgery-surgeons.json"}],"sources":{"C17":{"id":"C17","title":"STS Adult Cardiac Surgery Database Monthly Webinar, May 6, 2026 — Treatment of Preoperative Atrial Fibrillation","url":"https://www.sts.org/sites/default/files/Database%20Webinar%20Handouts/ACSD%20Monthly%20Webinar%2005062026.pdf","publisher":"Society of Thoracic Surgeons","published":"2026-05-06","read_at":"2026-10-07","source_type":"Official society teaching slides reproducing guideline recommendations"},"C18":{"id":"C18","title":"Left Atrial Appendage Occlusion Study III — LAAOS III","url":"https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/52/LAAOS-III","publisher":"American College of Cardiology","published":"2023-10-19 (updated)","read_at":"2026-10-07","source_type":"Professional society summary of randomized trial"},"cleveland-profile":{"id":"cleveland-profile","title":"A. Marc Gillinov, MD | Cleveland Clinic","url":"https://providers.clevelandclinic.org/provider/a-marc-gillinov/4268438","read_at":"2026-10-07","source_type":"official_hospital"},"D01":{"id":"D01","title":"Conditions treated by heart surgery","url":"https://www.nhlbi.nih.gov/health/heart-surgery/conditions","publisher":"NHLBI","read_at":"2026-10-07","source_type":"Official medical information or guideline"},"cabg-balkhy-current":{"id":"cabg-balkhy-current","title":"Husam H. Balkhy, MD — UChicago Medicine","url":"https://www.uchicagomedicine.org/find-a-physician/physician/husam-h-balkhy","source_kind":"official_current_hospital_profile","body_access":"search_returned_substantial_page_body_read","support_location":"Title, current role, About, Specialties and Areas of Expertise","short_excerpt":"Director, Robotic and Minimally Invasive Cardiac Surgery","read_at":"2026-10-07","source_type":"official_current_hospital_profile"},"pd-adult-balkhy-official":{"title":"Husam H. Balkhy, MD","publisher":"UChicago Medicine","url":"https://www.uchicagomedicine.org/find-a-physician/physician/husam-h-balkhy","read_at":"2026-10-08","kind":"official provider or programme page","support":"Current professor/director role; TECAB, robotic mitral and atrial fibrillation surgery.","limitations":"An institutional listing supports current role and stated clinical scope; it does not establish the next appointment, operating allocation or individual risk-adjusted results.","body_file":"outputs/heart-surgery-hub-20261007/review/provider-depth/adult/sources/balkhy-official.txt"},"SP10":{"title":"Ali J. Khiabani, MD, MHA — physician profile","publisher":"WashU Medicine","url":"https://physicians.wustl.edu/people/ali-j-khiabani-md-mha/","read_at":"2026-10-08","source_kind":"official-institution","local_body":"/Users/eugen/Projects/frankenstein-agentic-framework/outputs/heart-surgery-hub-20261007/review/provider-depth/specialties/sources/recovered-official-web.json","supports":"Current assistant professor, cardiac surgeon at Barnes-Jewish, minimally invasive AF/valve surgery; research in arrhythmia surgery and outcomes; 2024 cardiothoracic fellowship.","limitations":"Direct HTTP returned 403; complete relevant body recovered with web reader. No personal Maze annual volume or long-term rate is reported."},"SP19":{"title":"The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation.","publisher":"The Journal of thoracic and cardiovascular surgery","url":"https://pubmed.ncbi.nlm.nih.gov/32563577/","read_at":"2026-10-08","published_at":"2020-05-05","doi":"10.1016/j.jtcvs.2020.04.100","pmid":"32563577","source_kind":"primary-research-abstract","local_body":"/Users/eugen/Projects/frankenstein-agentic-framework/outputs/heart-surgery-hub-20261007/review/provider-depth/specialties/sources/pmid-32563577.json","supports":"WashU Cox-Maze IV programme 853 operations during 2003–2018; Khiabani first author; rhythm durability and recurrence predictors.","limitations":"Historical programme cohort, not operations by Khiabani. Follow-up denominators shrink; no randomized comparison with catheter ablation; long-term freedom-from-arrhythmia is not cure."}}}