Atrial Fibrillation Surgery/Maze Procedure
Atrial fibrillation, AF, is one of the most common heart rhythm problems in adults. It can lead to stroke, worsening of heart muscle function, and in patients with valvular heart disease or high blood pressure, significant worsening of a patient’s symptoms and quality of life. Most patients with atrial fibrillation require a blood thinner, Coumadin, to reduce the risk of stroke.
With atrial fibrillation, the upper chamber of the heart basically quivers and does not contribute to the filling of the lower chambers of the heart. Because of this, the heart rate of the lower chamber becomes irregular and can be extremely fast. When this occurs, the patient may feel lightheaded and notice palpitations and require medications to control the heart rate.
Atrial fibrillation may be paroxysmal, spontaneously occurring and reverting back to a regular rhythm and a medication, Coumadin, is recommended for these patients to reduce the risk of stroke. If the patient does not wish any medications for this problem and wants to be free of AF, there is an ablation procedure to consider. This can be accomplished during a catheterization procedure by an electrophysiologist or by the surgeon using small chest incisions.
Atrial fibrillation that is more long-standing is called “persistent” atrial fibrillation, formerly called chronic atrial fibrillation. This problem is more difficult to treat, especially when the upper chamber of the heart enlarges or it has been persistent for a prolonged period of time.
Although surgery for “lone atrial fibrillation” - that is AF not associated with other structural heart disease – is not commonly performed, it should still be considered when the patient is truly bothered by its presence and wants to avoid medications. More often, patients require surgery for other reasons, most commonly mitral valve problems, during which an ablation procedure can be performed at the same time.
Robert Bojar, M.D.
Over the past 10 years, numerous devices have been developed that use energy sources to simplify the procedure. These include radiofrequency, cryoablation (extreme cold), and high –frequency ultrasound. Most surgeons will use these devices in patients undergoing mitral valve surgery to ablate atrial fibrillation, but they can be used during any type of open-heart surgery.
Following a Maze procedure, most patients will need to take a blood thinner, Coumadin, as well as an anti-arrhythmic drug, amiodarone, for several months. Occasionally, the patient may be discharged home in atrial fibrillation, but will revert to and stay in a normal rhythm after several weeks.
Following an uneventful surgery, the patient remains in the hospital for about four to five days and then may be discharged home or to a rehabilitation hospital for a few days of additional care. Patients return for an x-ray, EKG and an office visit, usually two weeks after being discharged. Most patients feel quite well after one to two weeks, but need to limit some activities for about six weeks. It is important that patients become involved in supervised
cardiac rehabilitation. After 6 weeks, most patients are able to go back to work.
Robert Bojar, M.D.