Autonomic Maze Procedure
The autonomic MAZE procedure is done during an open-heart surgery procedure. It is typically done in conjunction with another open-heart procedure such as a heart valve repair or replacement, coronary artery bypass graft surgery, or congenital defect repairs. This procedure can be done with or without the use of the heart-lung bypass machine. This is a relatively new open-heart procedure for treating AF, however, recent studies show approximately 90% success after one year of maintaining normal sinus rhythm. Patients who suffer from atrial fibrillation should be considered for this procedure when having another open-heart surgery. 11 12
During the surgery, the doctor uses real-time mapping techniques to find the sources of atrial fibrillation in each patient’s heart. This means that the doctor uses special technology during the surgery to identify, or map, the areas of the heart where the abnormal electrical signals originate. Once these sites are found, they are safely and completely treated. There are also nerves on the heart which can trigger these abnormal electrical impulses. They are also identified during the surgery and safely treated. Because these areas are mapped for each patient and it is done from the outside of the heart, there is no damage to the muscle or lining on the inside of the heart. Each area that is identified and treated is then tested to ensure there is no conduction of electrical impulses across the treated tissue. This allows the doctors to ensure the treatments have been effective while the patient is still in the operating room. The procedure also involves removing a small area of the left atrium where most blood clots form called the left atrial appendage. This reduces the risk of stroke in patients with atrial fibrillation.
There is no additional recovery associated with the autonomic maze procedure. Having this procedure in conjunction with any other heart surgery would not lengthen the recovery period or prolong the healing process. Most patients remain in normal rhythm without rhythm-control medication. A fair portion of patients with chronic atrial fibrillation may have relapses in the early post-operative period. This is due to inflammation from the operation itself that causes some temporary irritability in the heart’s electrical system. The inflammation is gone in 3-4 weeks, leaving nearly all patients in normal sinus rhythm.
11 Mehall, JR, Kohut, RM, Schneeberger, EW, et al. Intraoperative Epicardial Electrophysiologic Mapping and Isolation of Autonomic Ganglionic Plexi. Annals of Thoracic Surgery 2007; 83: 538-541.
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