The Maze procedure is a surgical intervention that cures atrial fibrillation (AF) by interrupting the circular electrical patterns that are responsible for this arrhythmia. By creating surgical ablation lines in both atria the conduction of the erratic electrical impulses is stopped. This facilitate the and channel the normal electrical impulse in one direction from the top of the heart to the bottom. Scar tissue generated by the the ablation technology device permanently blocks the travel routes of the electrical impulses that cause AF, thus eradicating the arrhythmia. The major advantage the Maze procedure offers over other less-invasive forms of therapy is that it corrects all three problems associated with AF. The Maze procedure: restores sinus rhythm, facilitate the synchrony between the atria and the ventricles and preserves organized atrial contraction.

Watch an Interview with Dr. Ad about Maze

New concepts for the surgical treatment of atrial fibrillation were introduced in recent years when the surgical device industry introduced different ablation technologies to support various platforms for surgical ablation. As a result, cut and sew maze procedures are no longer performed on a regular basis and device based procedures are widely performed. All procedures include control of the left atrial appendage. The surgical procedures in use are:

The full maze procedure

• Median sternotomy - Performed through a midline incision and involving splitting the breastbone, a median sternotomy is offered to candidates for a combined procedure, such as coronary artery bypass grafting or valve surgery with indications for surgical ablation of atrial fibrillation. It is also offered to patients for a stand-alone procedure who are not eligible for the minimally invasive approach.
  
• Minimally invasive approach - Performed through a small seven centimeter right anterior throracotomy, the entire maze procedure is performed with the same high success rate.
  

Pulmonary vein isolation

• This procedure is offered to a subgroup of patients with intermittent atrial fibrillation. The procedure is performed through bi-lateral (left and right) incisions in the chest wall and includes left atrial appendage disarticulation.

Watch a Video about the Cut and Sew Maze

In some cases the procedure does require that the heart be stopped and the heart-lung bypass machine used. This is because surgeons need to work on a non-beating heart in order to create the ablation lines. Heart-lung bypass supplies blood flow and oxygen to all of the body's organ systems to protect them while the heart is stopped. In modern atrial fibrillation surgery, the use of the heart-lung machine have been reduced to minimum in most cases. Unlike the past the most of the procedure can be performed without the support of the heart-lung machine. Pulmonary vein isolation only is performed through bi-lateral incisions in the chest wall and without the use of heart lung machine.

The length of the operation varies depending on the complexity of the surgical procedure and the approach that is used. The actual Maze procedure itself takes about an hour. The remainder of the time is spent safely engaging and disengaging from bypass, opening and closing the chest, and inserting the necessary pressure monitoring lines. The approximate total time in the operating room for a Maze procedure is about 2-3 hours.

The Maze procedure cures atrial fibrillation about 95 % of the time. Among U.S surgeons reporting their data in the January 2000 issue of Seminars in Thoracic and Cardiovascular Surgery, the overall success of the Maze procedure ranged from 90 - 97%. Of the patients studied, three percent required medication after the procedure in order to maintain normal sinus rhythm.

Fluid retention is sometimes a complication after the surgery. However, patients who take diuretics for the first six weeks after the surgery usually overcome the problem. Other complications include bleeding, wound infection, stroke and pneumonia. These are possible complications with any open-heart surgery procedure.

Yes, the Maze procedure is frequently performed with other cardiac surgical procedures such as coronary artery bypass grafting, mitral valve repair and/or valve replacement.

Each patient experiences paid differently. In general, the sternum has relatively few nerve endings making it a dull area of the body. Most patients who have chest surgery complain of aching around the incision and general discomfort between the shoulder blades. Patients are encouraged to take pain medication as needed. Some patients find that a neck pillow is useful in reducing the shoulder aches and pains after surgery.

The typical post-operative recovery time is about 4 weeks after surgery. While the decision about when to return to a full schedule depends on each patient, those with physically demanding jobs may have a recovery as long as three months.

By the end of 3-6 weeks patients should expect to be back to their normal energy prior to surgery. Our data show that general health improves througout the first year with the most significant improvements in the first three to six months.  Cardiac rehabilitation, a structured and monitored work out program helps many people recover from surgery.

An echocardiogram is essential for all patients prior to a Maze procedure. The echocardiogram is an ultrasound study of the heart that helps physicians evaluate the structure and the function of the heart and the valves. In addition, diagnostic tests including lab work, an electrocardiogram and a chest x-ray will be required prior to surgery.

Patients over the age of 40 and those with clinical evidence of heart abnormalities or suspected heart conditions will undergo cardiac catheterization to assess cardiac function. A cardiac catheterization can be performed as an outpatient visit by an interventional cardiologist. The catheterization film will be forwarded to your heart surgeon for review prior to surgery.  

If you have a pacemaker, you may still be able to have the Maze procedure. Pacemakers do not affect the surgical procedure and may even reduce the time spent in the hospital after the surgery.

Yes. Patients who have had an ablation procedure can still undergo the Maze surgery.

Since the procedure began in 1987, follow-up information has indicated no adverse or unexpected findings with the long-term patients.

The Maze procedure does not prevent further cardiac surgical interventions. However, scar tissue usually forms following any open-heart procedure, making a second procedure is difficult.

Atrial fibrillation occurs in 40-45 % of patients within the first three months after surgery. This is because following the surgery the atrial tissue swells and the rest periods become shorter, making it easier for an irregular beat to trigger AF. However, AF after surgery usually responds well to medication.

Because the Maze procedure is open-heart surgery, it is generally reserved for patients for whom medication has not been successful. Our average experience is that patients are in AF for three and a half years before undergoing the Maze procedure. To determine if a patient should have the Maze procedure, a full work-up is completed and then all of the available treatment options are discussed. Each case is unique and must have an individualized approach based on the circumstances.

Patients who are unaware if they are in AF or a normal rhythm are probably not appropriate candidates for the Maze procedure. Generally, patients undergo surgery to relieve symptoms associated with AF and improve quality of life.