Maze (Cox-Maze III) Surgery
In 1987, Dr. James Cox pioneered a surgical procedure to cure atrial fibrillation. Called the Cox-Maze procedure, it involved a complicated set of incisions made in a maze-like pattern on the left and right atrium (the upper chambers of the heart) to permanently interrupt the abnormal electrical signals that cause irregular heartbeat. When these incisions healed, the resulting scar tissue blocked the erratic electrical impulses that caused atrial fibrillation, which could no longer be conducted throughout the heart.
The Cox-Maze III procedure, called the "cut-and-sew-Maze", evolved after multiple iterations. It is performed during open-heart surgery and is the gold standard for treating and curing atrial fibrillation.
A study at Washington University in St. Louis of their results with Cox-Maze III showed a greater than 96% cure rate 10 years after surgery. 1 Those are staggering results for a procedure that many afib patients have been told they just have to "live with." Freedom from stroke from Maze surgery is generally in excess of 99%.
However, Cox-Maze III is extremely technically complex, thus few surgeons do it. Complications are common, as shown in a Mayo Clinic study of Maze procedures from 1993 to 1999 that found an early mortality rate of 1.4% and the need for pacemakers in 3.2% of patients. 2
The newest iteration is Maze surgical ablation, Cox-Maze IV. Instead of incisions, Cox-Maze IV uses one of several possible energy sources to scar the tissue and create a conduction block that stops errant electrical signals from progressing into the atria and throughout the heart. Two variations are:
- Maze surgical ablation, an open chest procedure for those needing open-heart surgery for other reasons.
- Mini-Maze surgical ablation, a minimally-invasive closed chest procedure for those just needing a cure for afib.
To learn more about either variation, follow the links above.
1 Damiano, Ralph J., Jr, MD, "Alternative energy sources for atrial ablation: judging the new technology" <http://ats.ctsnetjournals.org/cgi/content/full/75/2/329>, The Annals of Thoracic Surgery, 2003;75:329-330
2 Schaff H, et al, "Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience" <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10746920&dopt=Citation>, Seminars in Thoracic and Cardiovascular Surgery, 2000;12:30-37.
