Maze procedure for atrial fibrillation

Surgery Overview

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The maze procedure is a surgical treatment for atrial fibrillation. The surgeon can use small incisions, radio waves, freezing, or microwave or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia. The scar tissue directs electric signals through a controlled path, or maze, to the lower heart chambers (ventricles).

The maze procedure is usually done during open-heart surgery and has been reported to correct atrial fibrillation in 90% to 99% of people.^{1 2} However, because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and do not respond to medication or other treatment. Doctors are developing catheter-based maze techniques that are less invasive than current surgical maze techniques. These techniques may be less painful and require less recovery time.

The maze procedure is frequently performed with other necessary cardiac surgery, such as coronary artery bypass and valve repair or replacement.

What To Expect After Surgery

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You will have to stay in the hospital for about 7 to 10 days. Most people spend the first 2 or 3 days after surgery in an intensive care unit (ICU) where they can be closely monitored. You will be encouraged to walk within 1 to 2 days of your surgery.

Discomfort in the chest, ribs, and shoulders is common within the first several days following surgery. Your doctor will order pain medications to help control this discomfort.

Medications called diuretics are used to control fluid buildup immediately after surgery. Your doctor may have you take a diuretic at home for several weeks following surgery.

You may need to take an anticoagulant, such as warfarin (Coumadin, for example) after the procedure. However, this is usually determined on a case-by-case basis.

Recovery is generally complete within 6 to 8 weeks following surgery. Some people have discomfort at the chest incision for several months following surgery.

You will be able to get back to your normal activities within 3 months of surgery. You may feel more tired than usual, but most people are back to normal within 6 months.

Newer, less invasive surgical techniques are being developed. These techniques should reduce the recovery time needed for this surgery.

Why It Is Done

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The maze procedure is a surgical treatment for atrial fibrillation. It is used to control the irregular heartbeat and restore the normal rhythm of the heart.

How Well It Works

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The maze procedure has been reported to correct atrial fibrillation in 90% to 99% of people.^{1 2}

Risks

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The risks of the maze procedure are similar to the risks of any heart surgery and include:

• Bleeding.
• Infection.
• Stroke.
• Pneumonia.
• Heart attack (myocardial infarction, or MI).
• New arrhythmias.
• Needing to have a pacemaker implanted.
• Death.

What To Think About

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Because of the risks involved with open-heart surgery, the maze procedure is recommended only for people who have severe symptoms that have not responded to medication or other treatment.

You may need to have a blood transfusion following the maze procedure. Talk with your doctor and find out whether it is possible for you to donate your own blood to be used during the procedure.

Some people need a pacemaker after the maze procedure.

The maze procedure is being done experimentally using a catheterization technique. The catheter is a thin, flexible tube threaded through blood vessels, and it allows the procedure to be performed without opening the chest. Catheterization is an alternative to open-heart surgery, but this technique is still under study. As techniques using catheterization improve, this method of doing a maze procedure likely will become a more standard treatment option.

The maze procedure is very expensive and may not be covered by your health insurance. It is only available at specialty medical centers.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Schaff HV, et al. (2000). Cox-maze procedure for atrial fibrillation: Mayo Clinic experience. Seminars in Thoracic and Cardiovascular Surgery, 12(1): 30–37.

2. Cox JL, et al. (2000). Current status of the maze procedure for the treatment of atrial fibrillation. Seminars in Thoracic and Cardiovascular Surgery, 12(1): 15–19.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Laurence Epstein, MD - Cardiac Electrophysiologist
Last Updated	January 18, 2007