Maze procedure for atrial fibrillation

Surgery Overview

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. The maze procedure can stop atrial fibrillation in most people.¹ But 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 medicine or other treatment. This surgery may also be done with less invasive techniques, but this type of surgery is still experimental.

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

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 medicines to help control this discomfort.

Medicines 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. But 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

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.

Your doctor may recommend the maze procedure if at least one of the following descriptions is true about you:

• You have symptoms of atrial fibrillation and are having another heart surgery.
• You are having another heart surgery and adding the maze procedure is not too risky.
• You cannot have catheter ablation.
• You have already had catheter ablation but still have atrial fibrillation.

How Well It Works

The maze procedure has good long-term results for treating atrial fibrillation. This surgery has been shown to stop atrial fibrillation for at least 5 years in 92 out of 100 people.¹

Risks

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

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 with less invasive techniques compared to open-heart surgery.

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.

Author:	Robin Parks, MS	Last Updated: December 18, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine John M. Miller, MD - Electrophysiology
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