THE MAZE PROCEDURE

Imagine a piano duet where one pianist plays a march while the other plays a lullaby. Hard as the slower pianist tries to keep the tempo, the faster pianist makes the slower one speed up too. The result is a song with no recognizable rhythm. For more than 2 million Americans, their heart rates are like the tempo of that piano duet. The upper chambers of their hearts beat faster than the lower chambers. The resulting rhythm is irregular and often fast [Mayo Clin Health Lett 1995].

Atrial fibrillation is the most common form of irregular heartbeats, known as arrhythmias. In atrial fibrillation, the tissue in the top chambers (atria) of the heart beats chaotically and ineffectively, sometimes causing the formation of blood clots that can lead to life-threatening stroke (click here for a description and illustration of the human heart).

The maze procedure is a newly developed surgical procedure for atrial fibrillation. It involves carefully placing a "maze" of incisions in the atrium to stop the electrical impulses causing the atrial fibrillation from spreading. It is generally a treatment of last resort; only after multiple medications have failed would most cardiologists consider it.

The maze procedure requires open heart surgery and it is very specialized surgery, done at only a few medical centers. Some centers are now experimenting with performing the maze procedure with catheters (not requiring open heart surgery), but at present this is highly experimental. The maze procedure performed as open heart surgery has a high success rate for sustaining normal heart rhythms, usually without the need for a pacemaker. Some patients, though, may still need to take medications after the procedure.

The most important thing for patients to do is to make sure they have exhausted all other medical and non-surgical options before having the maze procedure performed. They should definitely have an evaluation by a cardiac electrophysiologist—a cardiologist who specializes in atrial fibrillation.