Atrial Fibrillation - Open Heart Maze

ATRIAL FIBRILLATION | CAUSES & SYMPTOMS | DIAGNOSIS & HEALTH RISKS | TREATMENTS

OPEN HEART MAZE | TOTALLY THORACOSCOPIC MINI-MAZE | TT MINI-MAZE PATIENT CENTER

MAZE SURGERY FOR ATRIAL FIBRILLATION:

History of the Maze Procedure
The Maze procedure was devised by Dr. James Cox more than 20 years ago as a surgical treatment for atrial fibrillation.  Known as the Cox Maze procedure, the original operation involved making multiple incisions through the muscle of the atrial chambers of the heart.  These incisions were immediately sutured and thus created a barrier that channeled the electrical impulse of the atria through a “maze” to ensure normal rhythm.  While very effective at curing atrial fibrillation, the earlier Cox Maze procedure has never been adopted by a significant number of heart surgeons because it is lengthy and complicated.

Scientific advances of the last decade have increased our understanding of atrial fibrillation, particularly paroxysmal atrial fibrillation. Technologic advances, particularly radiofrequency ablation and cryotherapy, have led to the development of several new surgical options. 

Open Heart Maze Procedure

The open heart maze is the most invasive surgical treatment of atrial fibrillation; however, it offers the greatest cure rate.  This surgery involves an incision through the breastbone, and the use of the heart-lung machine.  Instead of making incisions through the atrial muscle, the surgeon creates a maze of scars in the atria using different forms of energy, either radiofrequency or cryotherapy.  The electrical impulse is then channeled through the atria to create a normal sinus rhythm.  In addition, the left atrial appendage is occluded, minimizing the accumulation of stroke-causing blood clots.  For lone atrial fibrillation, AFib with no structural heart disease, the cure rate is 95%.

The open heart maze surgery usually takes 3 – 4 hours.  Patients stay 2 nights in the surgical ICU and are usually discharged on the 4th day after their operation.  Their convalescence is similar to that of patients who have undergone other open heart surgeries, with a gradual increase in activity and exercise.  Patients usually return to driving and light work after a month and have unrestricted activity after 2 months.

The most common use of the open heart maze is as an adjunct to another open heart operation.  For patients with atrial fibrillation undergoing coronary artery bypass surgery or heart valve surgery, the open heart maze procedure can be performed in 20 – 30 additional minutes.

History of the Mini-Maze Procedure
Minimally invasive surgical approaches to treat atrial fibrillation began with Dr. Randall Wolf in 2003.  In this context, minimally invasive refers to performing the operation through several small incisions in the chest, rather than dividing the sternum, and eliminating the use of the heart-lung machine.  The result is less trauma to the tissues, less pain for the patient, and faster recovery.

Dr. Wolf’s procedure was primarily designed to treat paroxysmal atrial fibrillation.  The pulmonary veins are the trigger site for paroxysmal AFib in over 90% of cases.  By using radiofrequency energy, a scar is created encircling the pulmonary veins.    The scar effectively isolates the abnormal electrical impulses in the pulmonary veins, preventing the impulses from reaching the atria and causing the onset of AFib.  The success rate with this treatment is 85% for paroxysmal atrial fibrillation. 

For an appointment in Dr. Pigott’s AFib Clinic at Tulane Medical Center
Call:  504-988-AFIB (2342)
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