The Maze procedure has revolutionized care for patients who live with atrial fibrillation, also known as AFib, who have significant, frequent AFib symptoms that do not respond to medication or traditional ablation.
Maze is a surgical ablation approach that creates a 3-dimensional maze of incisions to form scar tissue that blocks the abnormal electrical patterns responsible for the arrhythmia (AFib). For select patients, the Maze procedure may:
- Restore sinus rhythm
- Synchronize the atria and ventricles
- Maintain an organized heartbeat
Maze may not be the right choice for patients who are unaware of their AFib symptoms. However, each case is unique so it’s best to discuss your options with your physician.
Kinds of Maze Procedures
- Median Sternotomy: Involves a midline incision and splitting of the breastbone and is often performed in conjunction with coronary artery bypass grafting, mitral valve repair, and valve replacement.
- Pulmonary Vein Isolation: Performed on patients with intermittent AFib. It involves bilateral incisions in the chest wall and separation of the left atrial appendage.
- Minimally Invasive Maze Procedure: Developed due to technological and surgical advances, our specialists perform this minimally invasive surgery with video-guided instruments through small keyhole incisions made between the ribs. Advantages include less pain and scarring, lower risk of infection, faster recovery, and earlier return to work and daily activities.
Frequently Asked Questions about the Maze Procedure
How does the Maze procedure work?
The procedure creates a 3-dimensional maze of incisions to form scar tissue that blocks the abnormal electrical patterns responsible for the arrhythmia. The Maze corrects all three problems associated with Atrial Fibrillation (AFib) at once: restoring sinus rhythm, synchronizing the atria and ventricles and maintaining an organized heartbeat.
What types of Maze techniques are available at Inova?
Maze techniques include traditional open surgery, which is frequently performed with other cardiac procedures such as coronary artery bypass grafting and mitral valve repair or replacement, and a minimally invasive version, which is less traumatic to patients. Benefits include smaller incisions, less post-operative pain, fewer complications and faster recovery.
Who is eligible for the Maze procedure?
Generally, patients with significant, frequent AFib symptoms that do not respond to medication or ablation. Patients who are unaware of their AFib symptoms are probably not candidates for the Maze procedure. However, each case is unique so it's best to discuss your options with your physician.
It is possible to have the Maze procedure if you have had other cardiac surgery, or if you have a pacemaker, but your physician will need to review your medical records and evaluate your case.
What should I expect before, during and after Maze surgery?
- Pre-op: An echocardiogram (ultrasound study of the heart) is essential for all patients prior to a Maze procedure. Other pre-surgical tests include lab work, an electrocardiogram and a chest X-ray. Patients over 40 and those with clinical evidence of heart abnormalities or suspected heart conditions will undergo cardiac catheterization to assess cardiac function. Your surgeon will review the results prior to surgery.
- Surgery: During surgery, the heart may be stopped and a heart-lung bypass machine used. This is because surgeons need to work on a non-beating heart to create the ablation lines. Heart-lung bypass supplies blood flow and oxygen to all of the body's organ systems to protect them while the heart is stopped. Total time in the operating room is usually about two to three hours. The Maze procedure itself takes about an hour. The remainder of the time is spent safely engaging and disengaging from bypass, opening and closing the chest, and inserting the necessary pressure monitoring lines. Minimally invasive Maze surgery takes less time than the traditional version.
- Post-op: Post-surgical pain varies by individual. Most patients complain of aching around the incision and general discomfort between the shoulder blades. A neck pillow can help reduce shoulder aches and pains. Fluid retention is sometimes a problem. Taking diuretics for the first six weeks or so can alleviate it. Other possible complications include those associated with any open-heart surgical procedure: bleeding, infection, stroke and pneumonia. Most patients stay in the hospital an average of three to five days while the atrial tissue swelling decreases and sinus node function returns. Usually, patients stay in intensive care for one to two days and then move to a step-down unit.
- Recovery: Once home, the typical post-operative recovery time is about four weeks. At this point, most patients are back to their normal energy levels. But decisions about whether to resume activities and return to work depend on each individual. Most patients take Coumadin (an anticoagulant) for about 12 weeks following surgery.
- Superior follow-up care: Our atrial fibrillation program features unique, long-term follow-up that meticulously monitors each patient's medical progress and quality of life in the months and years after Maze surgery. Patients are surveyed regularly and outcomes data is continuously reviewed. The information is used to evaluate risks and benefits of the Maze procedure, tailor medications, drive research and develop new, less invasive treatments for future patients. This rigorous follow-up is distinctive among heart centers across the country, where patients are typically released back to their physicians with no further contact after surgery.
Data show that general health improves throughout the first year, with the most significant improvement in the first three to six months. Participating in a cardiac rehabilitation program speeds recovery and enhances overall health.