Maze Procedure for Atrial Fibrillation

Surgery Overview

The maze procedure is a surgical treatment for atrial fibrillation . It can also be called a surgical ablation.

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 can be done in different ways. It may be done through small cuts in the chest. Or it may be done during open-heart surgery.

The maze procedure may be done if a person is having another heart surgery, such as coronary artery bypass and valve repair or replacement.

What To Expect After Surgery

Recovery for a maze procedure depends on how your surgery was done. For example, recovery will likely be longer for an open-heart procedure than for a less invasive procedure.

You may 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 watched. 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 right 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 typically complete within 6 to 8 weeks following surgery. Some people have discomfort at the chest incision for several months after surgery.

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

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: 1

  • Rhythm-control medicine has not worked to relieve your symptoms from atrial fibrillation.
  • You have symptoms of atrial fibrillation, and you 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, or you prefer to have surgery.
  • You have already had catheter ablation, but you still have atrial fibrillation.

How Well It Works

The maze procedure has good long-term results for treating atrial fibrillation. It can stop atrial fibrillation in about 9 people out of 10. 2 You may need to take heart rhythm medicine ( antiarrhythmics ) after the procedure.

Risks

The risks of the maze procedure are similar to the risks of any heart surgery that uses a heart-lung bypass machine.

Risks include:

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.

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

References

Citations

  1. Calkins H, et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm, 9(4): 632–696.e21.
  2. January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Other Works Consulted

  • January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.
  • Robertson JO, et al. (2014). Illustrated techniques for performing the Cox-Maze IV procedure. Annals of Cardiothoracic Surgery, 3(1): 105–116. DOI: 10.3978/j.issn.2225-319X.2013.12.11. Accessed June 16, 2014.

Credits

ByHealthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John M. Miller, MD, FACC - Cardiology, Electrophysiology

Current as ofAugust 5, 2014