One of the best EPs in the country has determined that traditional femoral vein access would no longer be appropriate for me, since I have a left sided inferior vena cava with a funky kink just north of the hepatic vein. It would make it difficult to thread the trans septal sheat up in to the right atrium -- it's the biggest piece of hardware. He recommended that I consult with the surgeon. He has recommended Dr. John Sirak at Ohio St. University. He is expert at the 5-box mini maze:

http://www.ohioafib.com/maze-surgery/

So... if you were 36 years old, in my shoes, what would you do? I have a solid 12-hour bout of a-fib 1-2x per week. I can no longer run, bike, or hike -- just moderate walking. I had a bizarre clotting abnormailty on the trans septal sheath during an attempt at catheter based ablation last November. I've failed Rythmol and Flecainide. My EP suggested we could load with Sotalol at the hospital and see if I am responsive. Are any of you responsive to Sotalol? Would it behoove me to try Sotalol before signing up for the Mini Maze.

I find the Mini Maze very attractive. It looks like success rate can be upward of 90%, compared to the standard 70% with catheter based ablation, since the pulmonary vein isolation is actually just one of 5 procedures carried out during the Mini Maze. I'm especially intrigued by the ectopic mapping -- I just sort of know that my heart is ectopically active, whereby electrical activity is derived from not just the pulmonary vein. I'm also curious about the removal of the left atrial appendage. Is this safe?

I also feel more at ease with work being done on the outside of my heart than the inside.

Clearly, lots of questions. I will at least schedule the consult with Dr. Sirak, but it was a humbling day when I heard that standard catheter ablation would not work well on me.

Thanks for listening!
Sean