Atrial fibrillation (AFib) is a serious heart condition that can lead to stroke and other problems. For some with AFib, medications are enough. Others find relief from a treatment called ablation. But if those treatments don't work, you may need a type of surgery called the maze procedure.
To know why the maze procedure can be effective, it helps to understand how AFib affects the electrical activity in your heart.
How Your Heart Works
Your heart runs on an electrical system. The heart's upper chambers (atria) beat in a synchronized way with the lower chambers (ventricles) to keep blood pumping through your body.
The electrical activity starts with a group of cells called the sinoatrial (SA) node. It sends out a signal that tells the atria to contract and move blood into the ventricles.
The signal then travels to another node -- the atrioventricular (AV) node. The signal from here makes the ventricles contract and push blood out to the rest of the body.
Any disturbance of your heart's normal rhythm is called an arrhythmia. AFib is one of the most common problems.
With AFib, your atria stop contracting normally and start to beat in an irregular and unpredictable way. This means that blood doesn't move through your heart properly. Instead of squeezing, the heart "fibrillates." This lack of contraction causes the blood to pool. This can cause lots of problems unless the heart rhythm gets back on track.
What Maze Surgery Does
Maze surgery got its name because it creates a maze for the heart's electrical activity. Think of it as a way to reroute those signals so they're back on track.
In an open-heart maze procedure, you'll get general anesthesia so you are "asleep." The surgeon will make several small cuts in a maze-like pattern in your heart's right and left atria. Scar tissue that forms around the surgical cuts acts as a buffer to keep the electrical signals on their new path.
The procedure takes 2 to 3 hours. During the operation, you'll be on a heart-lung machine so the surgeon can stop your heart in order to do the surgery.
With a robotic-assisted maze procedure the doctor doesn't have to stop your heart or cut open your sternum. The surgeon uses a robotic system to make smaller cuts on your chest between your ribs. Then the doctor does the operation through those cuts using a video-imaging system.
Who Gets It
Your doctor might consider maze surgery if AFib medications aren't effective at controlling symptoms or else cause serious side effects.
The procedure may also make sense if you have AFib and are having heart surgery for other reasons. For instance, the surgery may be to treat valve disease or blocked coronary arteries.
Before any surgical procedure, it's wise to discuss the risks and benefits of the surgery with your doctor.
The possible risks are like those from other types of heart surgery. They include:
- Heart attack
- Bleeding problems
- New arrhythmias developing
The main benefits are fewer or possibly no more symptoms and a lower risk of blood clots and stroke. You may also feel more energetic and be able to exercise longer than you have in some time.
Prep for Surgery
Like any operation, your doctor will let you know what you need to do in advance. You and he will review all your medications and any supplements you're taking in case you need to stop some before the surgery.
He'll also advise you to avoid eating or drinking after midnight the day before the procedure. Having an empty stomach makes it less likely that you will get sick under the anesthesia.
You will get general anesthesia. That means you won't be "awake" during the procedure. If you've had prior problems with general anesthesia, tell your doctor before the day of the surgery.
After the Procedure
Your recovery time will depend on which maze procedure you have.
If it's with open-heart surgery, you should plan on staying in the hospital for about a week. Overall, it will take about 2 months to recover provided there are no complications.
If you have a robotic-assisted procedure, you may only need to stay in the hospital a day or two after the surgery. You will also be able to return to normal activities sooner than if you have open-heart surgery. It will take about 6 months for the scars to fully form.
You may still have a few episodes of AFib during your recovery. But for many people, this procedure is successful at stopping their symptoms.