The "Maze" Procedure for Atrial Fibrillation

About twenty years ago a cardiac surgeon, James L Cox, created the "Maze" procedure to cure atrial fibrillation. In this procedure the left atrium is opened and series of incisions are made around the pulmonary veins, and are then over-sewn. Additional incisions to other areas within the left atrium are also made and over-sewn. The scars that form from these incisions are "isoelectric," which means they cannot pass electrical impulses. This serves to block these impulses from escaping the rotars. When developing this technique, Dr. Cox equated it to a maze from which the electrical impulses could not escape.

Over the last 20 years, probes utilizing different energy sources that cause the same set of scars have been developed. While not as effective as the cut-and-sew approach taken by Dr. Cox, these new probes can provide cure rates of 80 - 90%, in a minimally invasive format. Some of these probes are "endocardial" catheters that can be used inside the heart by an electrophysiologist, while others are called "epicardial" probes, with the work done from outside the heart. The ability of these probes to create lesions that will cure atrial fibrillation depends on a number of factors including the size of the patient's left atrium.

The advantage of epicardial ablation is that it has less complications associated with it than endocardial ablation (e.g. stroke and damage to surrounding tissues) and that it is overall more effective than endocardial ablation. Occasionally, however, a combination of the two is required to effect a cure.

At the Stamford Heart and Vascular Institute all cardiac surgery patients with atrial fibrillation are considered for ablation as part of their surgery, since the ablation procedure has a high success rate while adding very little time or risk. In most cases this procedure is performed from outside the heart (or epicardially).

For more information or to make an appointment please call 1-203-276-4777.

For more information or to make an appointment please call
1-877-233-WELL (9355).