Procedures & Innovations Atrial Fibrillation Surgery

The Maze Procedure

What is Atrial Fibrillation?

Atrial fibrillation is a form of arrhythmia, or irregular heartbeat, in which the atria (the two small upper chambers of the heart) quiver instead of beating effectively. While there are a number of variations of atrial fibrillation with different causes, they all involve irregularities in the transmission of electrical impulses through the heart.

As a result of abnormalities in the heart's electrical impulses, the heart is not able to pump the blood out properly, and it may pool and clot. If a blood clot moves to an artery in the brain, AF can lead to stroke. AF is also associated with increased risks of congestive heart failure and cardiomyopathy. These risks warrant medical attention for patients with AF even if the symptoms are mild.

What is the Maze Procedure?

The Maze Procedure is a surgical procedure that cures atrial fibrillation by interrupting the electrical impulses that cause the abnormal heart rhythm. The surgery involves the placement of incisions in both atria. When the incisions heal, scar tissue forms and prevents the abnormal electrical impulses from passing through the heart. Simple in concept, the Maze Procedure works essentially by creating blocks that the electrical impulses can not cross. In so doing, it corrects all the major problems associated with atrial fibrillation: it stops the atrial arrhythmia, it restores normal rhythm between the atria and the ventricles, and it preserves the ability of the atria to contract on its own.

Minimal Access Maze Procedure—Innovations at the CUMC Heart Institute

Surgeons at the CUMC Heart Institute have developed a minimal access technique in which a catheter can be inserted through a small incision outside the heart. Instead of making surgical incisions, a radiofrequency device is used to create the lesions on the atria. Research is now underway to investigate performance of radiofrequency Maze Procedures without placing patients on a bypass machine during surgery.

Safety and Success of the Maze Procedure

The Maze Procedure is highly effective in curing atrial fibrillation; studies indicate a success rate of 81%-97%. About 3% of patients continue to need medication to maintain their heart rhythm.

Open heart Maze Procedures may be performed in conjunction with coronary artery bypass grafting, mitral valve repair, and valve replacement.

Complications of surgery include fluid retention and other risks associated with heart surgery such as bleeding, infection, stroke, and pneumonia.