FAQ: Dr. Lishan Aklog Answers Patient Question About Whether to Use Amiodarone for Mini Maze Surgery

Q: How significant a role does amiodarone play in influencing the outcome of a Mini Maze? My surgeon wants me to take amiodarone, but I can barely tolerate beta blockers and do not want to take amiodarone.

Answered by Dr. Lishan Aklog:

The long-term outcome of the mini-Maze depends on the precise and complete creation of the ablation lines and the patient’s underlying anatomy (e.g., left atrial size) and physiology (frequency and duration of Afib, etc). It should not depend on Amiodarone.

The likelihood of Afib in the post-operative period is a different issue. As I assume you were told, it is very common for mini-Maze patients (or all heart surgery patients for that matter) to have episodes of Afib in the early post-operative period including up to the first 3 months. This Afib appears to be from a different mechanism (inflammation, healing from surgery) and therefore does not imply that the ablation did not work.

So the question is how to manage this post-operative Afib. It seems like your surgeon places patients on Amiodarone before surgery, in an attempt to decrease the chances of developing post-operative Afib. We generally do not do that (unless the patient is already on Amio) for two reasons. First, it does not dramatically reduce the chances of post-operative Afib. Second, it can slow the patient’s own native pacemaker function so that if the procedure is immediately successful and the patient goes into a regular rhythm, the rhythm can be too slow and require a prolonged period of time on a temporary pacemaker while the Amiodarone wears off.

Although we don’t start patients on Amiodarone preop, if they do develop fast Afib postop we typically treat them with Amiodarone since it is the most effective way of controlling the Afib rate. They are usually weaned off of it within 2-3 months of surgery, well before the complications of long-term Amiodarone kick in.

Beta blockers are a bit of a different story. If the patient is on a beta blocker for Afib rate control going into the surgery, they will usually need to continue it again for at least 2-3 months after the surgery. Stopping beta blockers can cause a “rebound” effect which causes the heart rate to go real high.

Again for either drug, if the procedure is successful, the goal would be to eliminate them within 2-3 months.

Lishan Aklog, MD, is Chair of The Cardiovascular Center and Chief of Cardiovascular Surgery at The Heart and Lung Institute of St. Joseph’s Hospital and Medical Center, Phoenix, AZ