What to Know About This Common Surgical Treatment for AFib
AFib is an electrical disorder, not a structural problem. Symptoms come when the automatic signals that tell your heart when to beat, and how hard to beat, aren’t working well. During an AFib episode, too many electrical signals bounce back and forth between the chambers, which causes the common thumping or fluttering feeling, and puts your heart at risk for pooling and clots.
A maze procedure (also known as surgical ablation) is one of the most direct ways to correct that faulty electrical communication in the heart. By changing the surface of the heart muscle in very specific ways, a heart surgeon can stop the extra electrical signals, and allow the important ones to travel along the appropriate pathway.
Surgical ablation could cure your AFib for good, although it may not be the right choice for every patient. Here’s what you should know if you and your doctor are considering a maze procedure for AFib.
How the Maze Procedure Works
A maze procedure can be done in a few different ways, but it will always involve three important aspects:
Compared to other operations, a maze procedure can be relatively simple and straightforward. A minimally invasive maze procedure (or mini maze) begins with keyhole incisions between the ribs, through which the surgeon guides a tiny camera and precise instruments to create spots of scar tissue on the heart. The heart is not stopped during the procedure.
However, 90% of maze procedures are conducted when the chest is already open for another heart operation. In the case of an open heart maze procedure, the surgeon will go through the breast bone to make a few small incisions on the left and right atrium. This procedure is more invasive, and your heart may be stopped for the course of the operation.
Your normal heart tissue conducts electricity well, but scar tissue does not. So, the purpose of the maze procedure is to create patches of scar tissue on the heart to stop electrical signals from passing through, which can be done with small incisions in open heart procedures, or microwave energy, ultrasound energy, or cryo-freezing when a mini maze procedure is used.
As these small wounds begin to heal, scar tissue develops, and electrical signals can no longer cross at those points. Instead, the blocked pathways force electrical signals to go down only one avenue from the SA node to the AV node, which will normalize the heart rhythm.
It’s not enough to simply scar some tissue in the heart — your surgeon must create very precise points of scarring to reroute the electrical signal to where it needs to go. The carefully scarred tissue forms a pathway that snakes down into the lower heart chambers, essentially leading the signal through a “maze” of tissue (which explains the name).
This method is remarkably effective for minimizing or curing AFib — 90% to 95% of patients will return to a normal heart rhythm within a year after the surgery. Recurrence is possible, but for many people, the results are permanent.