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Get in Rhythm. Stay in Rhythm.™ Atrial Fibrillation Patient Conference. Aug 4-6, 2017, in Dallas, TX
Get in Rhythm. Stay in Rhythm.™ Atrial Fibrillation Patient Conference. Aug 4-6, 2017, in Dallas, TX

What to Expect After Mini Maze Surgery

If you're having a mini maze procedure, what should you expect afterwards based on the experiences of other mini maze surgery patients?

In the Hospital

After surgery, you may be in the intensive care unit (ICU) anywhere from a few hours to a day or more and will be monitored very closely. Even after moving to a regular hospital room, expect to be hooked up to monitors so that the nursing staff can monitor your heart rate and blood pressure, and know how you are doing at all times. You may have other tests run as well to check your heart and lungs.

At your side, you may have a device that lets you self-administer pain medication. Some patients specifically mentioned using the pain medication, but our founder, Mellanie True Hills, recalls that the hospital staff kept asking her why she never used it. She was so out of it from the anesthesia that she didn't feel the pain, but felt reassured that the pain medication was there if needed.

To help you recover, you may be given a spirometer to use for breathing exercises to help keep fluid out of the lungs. Mellanie was still under intense anesthesia when they brought the spirometer, and if they told her how to use it, she doesn't remember. Reading through the information at this link before your surgery, and knowing how to use the spirometer, could shorten your hospitalization and hasten your recovery.

Once you leave the ICU and get settled into a normal hospital room, you'll start gradually walking. When the nurse told Mellanie "we're going for a walk around the nurse's station with a walker, and I'll help you," she wondered why she would need help. She soon learned just how wobbly she was, though she now realizes that the wobbliness was mostly due to the anesthesia, which was with her for a week.

After the procedure, you will go back on anticoagulants (warfarin or Coumadin®), and possibly antiarrhythmic drugs, for several months afterwards, which will vary from center to center. The HRS Expert Consensus recommends anticoagulants for at least 2 months afterwards,1 and it's generally about 3–6 months.

You'll likely go home after 2–4 nights in the hospital. Mellanie was in the hospital for 3 nights, which was the norm at the time of her surgery, but procedures have been streamlined such that stays are now shorter.

When compared to a week or more in the hospital with an open-chest maze procedure, this is significantly better. The recovery time is much shorter, too, and the risks are significantly less as well.

Problems Experienced

While the mini maze procedure is minimally-invasive compared to open heart surgery, it is still surgery, involving anesthesia, pain, soreness, tubes, recovery time, and risks.

Most mini maze patients don't experience any serious issues, though a few do. Here are some of the common things patients have told us that they experienced:

  • Chest tightness, soreness, pain, tenderness, and occasional swelling — many recommend getting some pain medication before the trip home.
  • Coughing or difficulty breathing at first, which resolved by doing breathing exercises with a spirometer to keep fluid out of the lungs.
  • Unusual heart rhythms — most were afib-free after surgery, but some experienced arrhythmias, such as slow or rapid heart rates or irregular heartbeats, which soon resolved. It isn't unusual for 30%–50% to experience skipped heartbeats or short afib episodes in the first three months after any heart procedure due to swelling and inflammation of atrial tissue. Just knowing to expect this can alleviate much of the anxiety associated with it.
  • Pain and irritation from drainage tubes was a common complaint — these tubes are placed in the chest following surgery to drain fluid from around the heart and lungs, and it's very uncomfortable to have them removed.
  • Nausea or feeling hung over from the anesthesia.
  • Fluid retention — one patient went home from the hospital ten pounds heavier, and the clothes worn to the hospital no longer fit several days later. It might be worth having loose, comfortable clothes to wear home and for a week or two afterwards. This may not impact some patients.

Though this list could be a little scary and intimidating, most of these things are insignificant compared to the after-effects of open-heart surgery.

A small percentage of patients may also experience sensitivity to anesthesia. The first night, Mellanie felt extremely nauseated, and then felt hung over for a week. Even though the amount of anesthesia was carefully calculated based on weight and body size, she received far too much, but has since learned that she's so sensitive to it that a half-dose is just about right.

It's also common for a small percentage of mini maze procedure patients to require a pacemaker afterwards. The percentage varies from center to center, and seems to vary by energy source used as well. You may want to ask about the pacemaker numbers for your specific surgeon.

Post-Surgery Follow Up

Expect to follow up with your doctor or surgeon — which one varies based on where you had your surgery and whether it was out-of-town — about a week after surgery, and again a few weeks later. Asking lots of questions in advance may help you make sure that the handoff from your surgeon to your cardiologist or primary care physician is as seamless as possible.

At your follow up visit, you may have an EKG or other tests to see how your heart is doing and ensure that the afib is resolved. Expect to have EKGs at 3–6 month increments over the first year, and annually after that.

In addition, you'll be asked to wear an event monitor for a few weeks to record any abnormal heart events, and will likely do so at 3–6 month intervals over the first two years. If things look good after wearing the event monitor the first time, you may be able to stop your atrial fibrillation medications.

Getting Back to Normal

Most mini maze patients seem to go back to walking and exercising within a few days, though regaining energy and muscle mass takes time. Most are back at work within a few days to two weeks after surgery. One went back to work just 2 days after leaving the hospital, but realized that was much too soon and hindered her recovery.

Over time, for most the incisions heal and leave only tiny scars, as shown in the drawing. Having these small scars is a very tiny price to pay for peace of mind that comes from a surgery that can cure your atrial fibrillation and eliminate your blood clot and stroke risk.

Mini-Maze Scars

Mini Maze Scars

Many mini maze patients, especially those with paroxysmal atrial fibrillation, are still afib-free several years after surgery, though some have minor incidents. Mellanie has had just one afib incident, and it was when her dentist gave her anesthesia that revved her heart up and brought on atrial fibrillation. Fortunately, medication resolved it within a few hours and she is still afib-free more than three years later.

One mini maze patient mentioned that he has a slower heart response to a "load," such as starting up stairs, but when the heart catches up, everything is fine.

The great news is that you don't have to endure a decade or two of atrial fibrillation while waiting for a cure.

And if you are younger than most atrial fibrillation patients, the mini maze procedure may be easier on you and your body. Incisions are becoming smaller and even less-invasive as the procedure evolves.

If you're a female interested in the mini maze procedure, see For Women Having Mini Maze Surgery.

Or learn more about Reclaiming Your Life after the mini maze procedure.

1 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up <http://www.hrsonline.org/News/Media/press-releases/CSAblation.cfm>, Heart Rhythm Society [Internet], Copyright, 2007.

Last Modified 5/7/2009

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