Atrial Fibrillation Surgery

The Maze procedure is a type of heart surgery used to treat atrial fibrillation.

The heart has 4 chambers. There are 2 upper chambers called atria and 2 lower chambers called ventricles. Normally, a specialized group of cells called the sinoatrial (SA) node in the upper right chamber of your heart, or the right atrium, provide the signal to start your heartbeat. With atrial fibrillation, the signal to start the heartbeat doesn’t begin in the sinoatrial node the way it should. Instead, the signal begins somewhere else in the atria. This causes the atria to quiver or “fibrillate.” The atria can’t contract normally to move blood to the ventricles. The disorganized signal spreads to the ventricles, causing them to contract irregularly and sometimes more quickly than they normally would. The contraction of the atria and the ventricles is no longer coordinated, and the ventricles may not be able to pump enough blood to the body.

In a traditional Maze procedure, the surgeon makes a number of small cuts in the atrium and then sews them back together. The heart’s electrical signal is not able to cross these cuts. The cut area now stops conducting the abnormal signals that caused the atrial fibrillation. The heart rhythm can therefore return to normal, and the heart can stop fibrillating. Traditionally, the Maze procedure is done as part of an open-heart surgery assisted with a heart-lung machine (cardiopulmonary bypass).

Instead of making cuts, doctors can use radiofrequency energy or freeze the tissue to disrupt the abnormal signals. These methods may allow the surgeon to use smaller incisions than would be necessary for traditional open-heart surgery. Sometimes the surgeon inserts a camera and small surgical instruments to perform the surgery.

Some people have unpleasant symptoms from atrial fibrillation, like shortness of breath. Atrial fibrillation also greatly increases the risk of stroke. Blood thinners used for preventing stroke pose their own risks, and some medicines require extra blood tests for monitoring.

Many people with atrial fibrillation take medicines to help control their heart rate or their heart rhythm. Although some people respond well to these medicines, others do not.

There are other surgical procedures as well as less invasive procedures, such as ablation, that are also options to control atrial fibrillation. Depending on your medical history, you may be a better fit for a particular procedure over another. Your doctor can review what options are best for you. He or she may recommend the Maze procedure if you already need open heart surgery to correct another problem, such as coronary artery disease or a heart valve problem.

Some, but not all people, may be able to stop taking anticoagulation medicine after the Maze procedure. Ask your doctor about the pros and cons of the procedure in your situation.

Though fairly rare, complications do sometimes happen. Rarely, some of these may be fatal. You may have specific risks based on your medical conditions. You are more likely to have complications if you are older or if you have other medical and heart conditions. Be sure to discuss all your concerns with your healthcare provider before your surgery. Risks can include:

• Bleeding
• Infection
• Blood clots, which might lead to a stroke or heart attack
• Other abnormal heart rhythms
• Kidney failure
• Complications from anesthesia

Another risk is that the procedure may not permanently stop atrial fibrillation. Sometimes, atrial fibrillation will come back shortly after the procedure or several months later.

Talk with your doctor about how to prepare for your upcoming surgery. Remember the following:

• Avoid eating or drinking anything after midnight before your surgery.
• Try to stop smoking before your operation. Ask your doctor for ways that can help you stop smoking.
• You may need to stop taking certain medicines before your surgery, like warfarin. Follow your doctor’s instructions.

You may need some routine tests before the procedure to assess your health before surgery. These may include:

• Chest X-ray
• Electrocardiogram (ECG), to assess the heart rhythm
• Blood tests
• Echocardiogram (Echo),to assess heart structure and function

If needed, someone will shave your skin above the area of operation. About an hour before the operation, someone will give you medicines to help you relax.

Talk with your doctor about what to expect about your Maze procedure. The following is a general description of the traditional Maze surgery, but your doctor may plan a less invasive procedure. Because the Maze procedure is commonly done in people needing heart surgery for another reason, the surgical process will vary. During a typical open-heart Maze procedure:

• A doctor will give you anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards, you won’t remember the operation.
• The operation will take several hours. Your doctor will make an incision down the middle of your chest and separate your breastbone.
• The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
• Your surgeon will make several cuts through the atria and then sew them back together. Alternatively, your doctor might use radiofrequency energy or another energy source to destroy small areas of tissue.
• Once complete, the surgery team will remove the heart-lung machine.
• The team will wire your breastbone back together.
• The team will then sew or staple the incision on your skin.

After your Maze procedure:

• When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
• The team will carefully monitor your vital signs, such as your heart rate. They will hook you up to several machines so that you are continuously monitored.
• You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
• You may have a chest tube to drain excess fluid from your chest.
• You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
• In a day or two, you should be able to sit in a chair and walk with help.
• You may do breathing therapy to help remove fluids that collect in your lungs during surgery.
• You will probably be able to drink liquids the day after surgery. You can have regular foods as soon as you can tolerate them.
• You will probably need to stay in the hospital around 5 days. It might be less than that if you had less invasive surgery.

After you leave the hospital:

• Make sure you have someone to drive you home from the hospital. For a while, you will also need some help at home.
• You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
• You may tire easily after the surgery, but you will gradually start to recover your strength. It may be several weeks before you fully recover.
• Ask your doctor when it is safe for you to drive.
• Avoid lifting anything heavy for several weeks.
• Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure