[2] Cox-Maze IV is now considered to be the "gold standard" for effective surgical cure of AF, but the results are institution dependent.
[citation needed] Efforts have since been made to equal the success of the Cox maze III while reducing surgical complexity and likelihood of complications.
In 2002 Saltman performed a completely endoscopic surgical ablation of AF[7] and subsequently published their results in 14 patients.
Shortly thereafter, Randall K. Wolf, MD and others developed a procedure using radiofrequency energy rather than microwave, and different, slightly larger incisions.
[citation needed] Today, the terms "minimaze", "mini-maze", and "mini maze" are still sometimes used to describe open heart procedures requiring cardiopulmonary bypass and median sternotomy, but more commonly they refer to minimally invasive, epicardial procedures not requiring cardiopulmonary bypass, such as those developed by Saltman, Wolf, and others.
These tubes are joined, then used to guide the flexible microwave antenna energy source through the sinuses behind the heart, to position it for ablation.
Energy is delivered and the atrial tissue heated and destroyed in a series of steps as the microwave antenna is withdrawn behind the heart.
A clamp-like tool is positioned on the left atrium near the right pulmonary veins, and the atrial tissue is heated between the jaws of the clamp, cauterizing the area.
Direct testing to demonstrate complete electrical isolation of the pulmonary veins, and that the ganglionated plexi are no longer active, may be performed.
All successful methods destroy tissue in the areas of the left atrium near the junction of the pulmonary veins, hence these regions are thought to be important.
[12] Supporting this is the finding that targeting these autonomic sites improves the likelihood of successful elimination of AF by catheter ablation.
Attaining a consensus is hindered by several problems; perhaps the most important of these is incomplete or inconsistent post-procedure follow-up to determine if atrial fibrillation has recurred, although many reasons have been considered.