Minimally Invasive Surgical Treatment Versus Medical Management for Stroke Patients With Atrial Fibrillation

• Quality of life satisfaction between patients treated surgically in stroke patients with atrial fibrillation [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Compare quality of life of patient satisfaction between the surgery and or the medication in stroke patients with AF with validated metrics.
• Quality of life satisfaction in stroke patients with atrial fibrillation treated medically. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Compare quality of life of patient satisfaction between the surgery and or the medication in stroke patients with AF (atrial fibrillation) with validated metrics.

• Comparison of Adverse Events between surgery management patients [ Time Frame: Baseline up to 6 months ] [ Designated as safety issue: Yes ]
  Compare adverse events between surgery and medical management patients, recurrent stroke,TIAs, AF burden, repeat interventions, bleeding and surgical morbidity. Maintaining NSR(normal sinus rhythm) and 6 months.
• Comparison of Adverse Events between medical management patients [ Time Frame: Baseline up to 6 months ] [ Designated as safety issue: Yes ]
  Compare adverse events between surgery and medical management patients, recurrent stroke,TIAs, AF burden, repeat interventions, bleeding and surgical morbidity. Maintaining NSR and 6 months.

The purpose of this study is to compare a minimally invasive surgical procedure and medication management in stroke patients with Atrial Fibrillation. The two treatment options are a minimally invasive surgical procedure or the use of medications.

Must have had a stroke or transient ischemic attack (TIA) and have Atrial Fibrillation

• Atrial Fibrillation
• Stroke

• Procedure: Minimally Invasive Surgery
  small thumb sized incisions are made on each side of the chest wall where instruments are inserted for the purpose of completing the surgery.
  Other Name: Minimally Invasive Maze Procedure
• Other: Medical therapy
  patients are treated with rhythm and rate control medications
  Other Name: Medical Management

• Active Comparator: Minimally Invasive Surgery
  Thumb sized incisions are made on each sides of the chest wall where instruments are placed in the chest to perform the surgery.
  Interventions:

  • Procedure: Minimally Invasive Surgery
  • Other: Medical therapy
• Active Comparator: Medical Therapy
  patients are treated with rhythm and rate control medications
  Interventions:

  • Procedure: Minimally Invasive Surgery
  • Other: Medical therapy

Inclusion Criteria:

• Patients with a history of stroke and paroxysmal, persistent or permanent AF.
• Ischemic stroke or TIA with documented paroxysmal or persistent atrial fibrillation. A TIA will meet inclusion criteria as a sudden-onset focal neurological symptom or sign lasting at least 10 minutes but less than 24 hours with or without evidence of acute brain ischemia on diffusion weighted MRI imaging.
• Eligible symptoms INCLUDE hemiplegia or hemiparesis, monoplegia, or language disturbance other than isolated dysarthria.
• Symptoms that will NOT QUALIFY AS TIA INCLUDE transient monocular blindness in both eyes, dysarthria, vertigo,isolated sensory symptoms, confusion, memory loss, nonspecific complaints of dizziness, or syncope.

Exclusion Criteria:

• Recent stroke (< 1 month).
• Age < 18 or > 80 years; Ejection Fraction < 25%• Presence of left atrial appendage thrombus on CT or echocardiography
• Previous empyema or thoracic surgery, preventing access to the pulmonary veins via thoracoscopy.
• Left Atrial Diameter > 55mm.
• Contraindication to anticoagulation with Coumadin.
• Mitral insufficiency (> 2+)
• • • Contraindications to MRI
• •Artificial heart valve prosthesis
• Aneurysm clips
• Implanted drug infusion device or pump
• Any type of neurotranstimulator
• Any type of bone growth stimulator
• Cochlear implants or inner ear prosthesis
• Any intravascular coils, filters, or stents
• Shrapnel or bullets
• Other metallic implants or devices specify which
• Permanently tattooed eyeliner
• Are you pregnant or suspect to be pregnant?