What Is the Maze Procedure?

A maze procedure is an operation. Your doctor may recommend you have a maze procedure to treat atrial fibrillation, also called AFib. AFib is a condition in which the heart loses its regular rhythm and beats too fast. It is a type of arrhythmia (uh-RITH-me-uh).^1,2

Your heart has 4 chambers, 2 at the top called atriums and 2 at the bottom called ventricles. A special group of cells live in the upper right chamber, the right atrium. These cells send electrical signals down to the ventricles. As the electrical signals travel, they tell the different parts of the heart to beat (contract).³

The goals of a maze procedure include:²

• Correcting AFib
• Controlling the heartbeat
• Preventing blood clots
• Reducing the risk of stroke

Your doctor may also call this surgery a Cox-maze IV procedure.²

What happens during a maze procedure?

During a maze procedure, your doctor creates a specific pattern, or maze, of scar tissue on your heart. The scar tissue lets normal electrical signals through and blocks abnormal signals. This helps the heart beat correctly.^2,4

The scar tissue is created in specific places using freezing (cryoablation) or radio waves (radiofrequency). This surgery may be performed:⁴

• As an open-heart surgery
• During an open-heart surgery for another heart condition
• As a minimally invasive surgery (called a minimaze)

If the maze procedure is done as open-heart surgery, there will be a 6- to 8-inch cut in the center of the chest bone (sternum) that holds your ribs together. During a minimaze, your doctor will make cuts in between your ribs.²

In another step during the surgery, your doctor will close what is called the left atrial appendage. This is a finger-sized pouch on the upper left side of the heart (left atrium). In people with AFib, the pouch is a common place for blood clots to come from. Blood clots can cause stroke. Closing this area of the heart reduces the chances of stroke.⁴

After surgery:^2,4

• You will stay in an ICU (intensive care unit) for 2 to 3 days.
• You will then move to a regular hospital room for a few more days.
• It will take at least 1 month to fully recover.

Who can benefit from a maze procedure?

A maze procedure may be a good choice for you if:²

• Drugs to control your AFib do not work or you cannot take them
• You are at high risk of blood clots
• You are having a bypass or valve surgery for a different heart condition and also have AFib
• You already had a catheter ablation surgery and it did not fix your AFib

A maze procedure can:⁴

• Correct or improve your AFib
• Ease the symptoms of AFib
• Reduce the chances of AFib complications
• Reduce the drugs you must take, such as blood thinners
• Other things to know

You will need a few tests before a maze procedure, including:^2,4

• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Chest CT (computed tomography) or chest x-ray
• Blood tests

Talk to your doctor about what to expect during a maze procedure and how to prepare. You will need to stop eating or drinking anything the night before your surgery. You may also need to take an extra drug or stop taking a drug before and after a maze procedure.^2,4

Do not stop taking any of your regular medicines without talking with your doctor first.²

There are other ways to correct AFib, such as:⁴

• Medicines (chemical cardioversion)
• Electrical cardioversion, which shocks the heart into a normal rhythm
• Catheter ablation

The maze procedure is successful 6 to 9 times out of 10, depending on the person’s other health conditions. Many people maintain a normal heartbeat for 10 years after a maze procedure.^2,4,5