What To Expect From Maze Surgery
Candidates for open chest Maze surgical ablation are usually those for whom atrial fibrillation isn't controlled by medication or who cannot take the necessary medication or anticoagulants, and who also need heart surgery for other reasons, such as valve repair or replacement or coronary artery bypass (CABG). In addition, those for whom catheter ablation has not worked and those with continuous afib may also be candidates.
Are You a Candidate for Maze Surgical Ablation?
Some patients with isolated (lone) atrial fibrillation undergo open chest Maze surgical ablation, but Mini-Maze surgical ablation may be a better option.
While this is sometimes an emergency procedure, it's normally an elective one done in conjunction with another heart procedure. After consulting with your surgeon to understand the procedure and determine if it's right for you, if you meet your surgeon's criteria and are a good candidate, you'll be sent for a pre-surgery evaluation that typically involves many of these tests:
- Complete physical
- Electrocardiogram (ECG)
- Echocardiogram
- Stress test or nuclear stress test
- Computed tomography (CT) scan
- Holter monitor
- Transesophogeal echocardiography (TEE)
- Blood work
From these test results, you and your surgeon will decide whether you can move forward with surgery and get you scheduled for it, and you'll be given pre-surgery instructions.
What to Expect from Maze Surgical Ablation
If you have Maze surgical ablation to correct your irregular heartbeat, here's what to expect. Surgery typically takes 2–4 hours, or more, and involves a 6–8 inch incision along the breast bone (sternum) and use of the heart-lung machine to oxygenate the blood and keep it circulating through the body. An energy source is directed to the pulmonary veins atop the atria to create a conduction block that isolates the pulmonary veins and keeps the erratic electrical impulses from moving through the heart.
During surgery, the left atrial appendage, a small ear-shaped flap in the left atrium is also removed to reduce the risk of blood clots and stroke, and is closed using a stapling device.
After surgery, you would spend 1–2 days in the intensive care unit (ICU), and several more days in a regular nursing unit, for a total of 5–7 days in the hospital. Recovery takes about 6–8 weeks.
About one-third to one-half of patients experience some atrial fibrillation or skipped beats within a few weeks to months after surgery due to swelling and inflammation of atrial tissue. A small percentage of patients, generally about 3%–6%, require a pacemaker following surgery as their afib masked underlying pacemaker issues. In reviewing studies, we've noticed that the numbers seem to be higher with some energy sources, as much as 20% in some cases.
You would likely be on a blood thinner afterwards as well as an antiarrhythmic medication, and perhaps also a diuretic to decrease fluid retention.
Patients are typically told to check with their doctor within a week after leaving the hospital, to follow up with their cardiologist within a month, and to have an EKG at 3 months, 6 months, and 12 months, and then each year afterwards.
