Atrial Fibrillation: How the Maze Procedure Works
Atrial Fibrillation Defined
Atrial fibrillation, often abbreviated as AFib, is a condition in which your normal heartbeat is changed. Abnormal electrical activity occurring in the upper portion of the heart, called the atria, causes an irregular heartbeat, called an arrhythmia. During an arrhythmia, your heart’s beating speed and pattern is altered. The maze procedure is a surgical intervention used to treat AFib when medications can’t adequately control frequent arrhythmias.
Goal of Surgery
The goal of maze surgery is to restore what is called the “sinus rhythm” or normal rhythm of the heart. The sinus node is located in the right atrium. This area of the heart is often referred to as your natural pacemaker, as it sets your heart’s regular beating pattern. Atrial fibrillation is a disorder that alters the sinus rhythm. Maze surgery destroys tissues that erroneously conduct the electric signals that control the rhythm of the heart. There are three types of maze surgery:
- open chest maze
Maze gets its name from a children’s maze. The path through which electrical impulses can move in your heart after maze surgery looks like the children’s game.
Preparation for Surgery
Preparation for a maze procedure begins a couple of weeks before your surgery date. At this time, you may be asked to stop taking certain medications, such as aspirin and other blood thinners. You may also be asked to stop smoking. You’ll also get blood work to confirm that you are infection-free. An electrocardiogram and chest X-ray lets your doctor see the current condition of your heart. You’ll fast the night before surgery to ensure your stomach is empty. This is because sometimes people become nauseated from anesthesia.
Open Chest Maze
The open chest maze procedure is the most invasive type of surgery for atrial fibrillation. Your doctor makes an incision in your sternum—the bony area that connects the right and left sides of your ribs—in order to access your heart. During surgery, your heart is temporarily stopped, and you’ll put a heart-lung machine to keep blood pumping through your body. Your surgeon makes a series of small cuts on the left and right side of your atria that are then sewn together to form scar tissue. Scar tissue is dead, not living, and isn’t able to conduct electricity to cause an irregular heartbeat. Open chest maze surgery can take up to six hours to complete.
Mini-maze is a minimally invasive procedure that accomplishes the same end goal as open-chest surgery. Instead of opening the chest to destroy the tissues that cause episodes of AFib, your doctor makes keyhole incisions on your right side, underneath your armpit. A tiny camera inserted into the holes lets your surgeon see the chambers of your heart. Radio waves that generate heat run through a catheter into your atria to destroy the faulty tissues. Mini-maze, due to its less invasive nature, takes less time than the open chest maze procedure: about three to four hours.
The cryomaze procedure uses extreme cold temperatures instead of heat to kill the area of the heart that causes the fibrillation episodes. The procedure is very similar to the mini-maze procedure. A catheter runs from incisions in your side to your heart. A cold probe freezes the offending sections on the right and left atria to block electrical activity. Cryomaze is relatively quick. Each “freeze” takes a minute or two to complete.
The length of recovery time after a maze procedure varies depending on the type of surgery you’ve had. Open surgery requires a longer hospital stay and more healing time. Most open-heart maze patients can return to work, school, and everyday activities between eight and 10 weeks after surgery. Mini-maze and cryo-maze procedures are minimally invasive, calling for a three- to-four day hospital stay. Your doctor will usually clear you to resume your regular routine within three weeks of your surgery date. Regardless of your surgery type, you’ll need to take blood-thinning medications and antiarrhythmic drugs for a time (specified by your doctor) after surgery. These medicines prevent blood clots and correct and residual beat irregularity post-surgery.
Maze procedure as a treatment for atrial fibrillation is highly effective. The Society of Thoracic Surgeons (STS) estimates that the specialized surgery restores normal function in 80 to 100 percent of AFib patients. The University of Maryland Medical Center (UMMC) states that, among its cryomaze patients, 77 percent are able to discontinue the use of blood thinning drugs within six months of surgery. While blood thinners reduce the risk of stroke—a possible complication associated with AFib surgery—the medications can also increase the risk of hemorrhage.
- Atrial Fibrillation. (2013). Stanford Hospital & Clinics. Retrieved July 2, 2013, from http://stanfordhospital.org/cardiovascularhealth/arrhythmia/conditions/atrial-fibrillation.html
- Atrial Fibrillation Surgery - Maze Procedure. (2013). STS. Retrieved July 2, 2013, from http://www.sts.org/patient-information/arrhythmia-surgery/atrial-fibrillation-surgery
- CryoMaze Procedure for the Treatment of Atrial Fibrillation. (2013). University of Maryland Medical Center. Retrieved July 2, 2013, from http://umm.edu/programs/heart/services/programs/surgery/cryomaze
- MAZE Procedure for Treatment of Atrial Fibrillation. (2013). Cardiothoracic Surgery, University of Southern California, Los Angeles. Retrieved July 2, 2013, from http://www.cts.usc.edu/mazeprocedure.html
- Minimally-Invasive Radiofrequency Ablation for Atrial Fibrillation. (2013). Johns Hopkins Medicine. Retrieved July 2, 2013, from http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/treatments/minimally_invasive_radiofrequency_ablation.html
- Preparing for Maze Surgery. (2013). Cedars-Sinai. Retrieved July 2, 2013, from http://www.cedars-sinai.edu/Patients/Programs-and-Services/Heart-Institute/Patient-Resources/Preparing-for-Cardiac-Procedures-and-Studies/Preparing-for-Maze-Surgery.aspx