Is your heart rhythm irregular? Let's talk about the Maze Procedure, a solution to Atrial Fibrillation!

Have you ever felt like your heart is beating like crazy, beating fast and irregularly, and you feel like you have a strange feeling in your chest? This is what we call Atrial Fibrillation (AFib) in medicine. This is a very common heart rhythm disorder. Most of the time, this condition can be controlled with medication. But for some people, it is difficult to control it with medication alone. At such times, today we are going to talk about a very successful surgery that doctors recommend. It is called the Maze Procedure . Although the name is a bit strange, it has been able to cure the lives of many people with AFib.

Simply put, what is this Maze Procedure?

Think of a maze game. There is only one way in, one way out, and only one right path in between. But there are also many wrong paths leading back and forth inside it. The same thing happens in the Maze Procedure.

Simply put, in this procedure, the surgeon creates a very delicate, planned pattern of scar tissue on your heart tissue. It's like creating a maze inside the heart.

Now look, what happens in the heart of someone with Atrial Fibrillation is that the electrical signals that control the heartbeat start in a chaotic manner, starting in one place and spreading to all four arms. This is why the heart loses its rhythm and starts beating rapidly.

The scar tissue pattern created in the Maze Procedure blocks the pathways for the irregular, incorrect electrical signals to travel back and forth . At the same time, the only path for the correct electrical signal to beat is opened . Like the correct path in a maze. This blocks all the incorrect signals and allows only the correct signals to travel. Eventually, your heart rate returns to a normal, healthy rhythm.

Doctors use two methods to repair this scar tissue:

• Cryoablation: Uses extreme cold (freezing) to damage tissue and cause scarring.
• Radiofrequency energy: Radiofrequency energy is used to heat tissue and cause scarring.

This procedure can sometimes be done at the same time as other heart surgery (such as bypass surgery). Or, it can be done alone. Today, the newest and most advanced form of this surgery, the Cox-maze IV procedure , is considered the "gold standard" for atrial fibrillation.

In what cases is this surgery performed?

The Maze Procedure is not recommended for all AFib patients. Your doctor will usually discuss this procedure with you if:

• If your prescribed medications are unable to control your heart rhythm , or if you cannot use certain medications due to side effects.
• If you have atrial fibrillation, which has caused blood clots to form in your body and caused dangerous conditions like stroke .
• If you are scheduled to have surgery for another heart condition (e.g., heart valve repair, bypass surgery) , this method can be used to treat your atrial fibrillation at the same time as the surgery.
• If you have previously undergone a treatment called Catheter Ablation and it was not successful.

What happens before the surgery?

You can't go for a surgery like this all at once. Before that, you need to thoroughly examine your body's condition. It involves several tests and doctor visits.

• Transthoracic Echocardiogram: This is like an ultrasound scan of the heart. It checks the size of your left atrium and whether there are any heart valve problems.
• Chest CT (Computed Tomography) Scan: A CT scan of the chest is done. Sometimes, if you are going to have minimally invasive surgery, you may also need to have a CT scan of the abdomen and pelvis.
• Meeting with the doctors: Your cardiologist, surgeon, and anesthesiologist will meet with you to explain the surgery, its risks, and how anesthesia will be administered. Ask any questions you may have at this time.
• Providing instructions: You will be given clear instructions on what to eat, drink, stop taking, and what medications to take in the days before surgery.

How is the surgery done?

The Maze Procedure can be performed in two main ways. Your surgeon will decide which method is best for your situation.

Because keyhole surgery (Thoracoscopic) is performed with very small incisions, there are fewer complications and a shorter hospital stay.

What is done to the Left Atrial Appendage?

This is a very important part of the Maze Procedure. The Left Atrial Appendage is a small, ear-shaped sac of tissue that is attached to the left atrium of the heart. This is the main site of blood clot formation in people with atrial fibrillation.

When the heart's rhythm is disturbed, the blood that enters this appendage stagnates there, making it more likely for blood clots to form. If a blood clot that forms in this way breaks free and travels along the blood vessels and gets stuck in a vein in the brain, it can cause a stroke.

Therefore, during the Maze Procedure, the surgeon closes this Left Atrial Appendage using stitches, staples, or a special device, or completely cuts it out. This can greatly reduce your risk of having a stroke in the future.

What happens after the surgery?

After the surgery, you will be kept in the intensive care unit (ICU) for observation for a day or two, and then transferred to a regular ward. If you have had other surgeries, your hospital stay may be longer. Typically, someone who has had keyhole surgery can go home in about four days. If you have had open surgery, you may need to stay for about a week.

Even after you go home, you will have to take some medications for several months.

• Anticoagulants (blood thinners): You will need to take these medications (e.g., warfarin, apixaban) for at least three months to prevent blood clots. After that, your doctor will decide whether you need to continue taking these medications.
• Heart rate control medications: These may be needed to control irregular heartbeats that may occur during the early stages of heart recovery.
• Diuretics: These medications are given to reduce the unnecessary accumulation of fluid in the body.

Sometimes, AFib is not completely resolved after the Maze Procedure. In such cases, an additional catheter ablation may be necessary. Therefore, it is very important to stay in touch with your cardiologist after the procedure.

What are the benefits and risks of this surgery?

How long does it take to heal?

It usually takes three to six weeks to get back to your normal daily activities. If you have had keyhole surgery, your recovery time will be much faster because there is no large incision in your chest.

When do you need to see your doctor again?

If you experience AFib symptoms again after surgery, notify your cardiologist immediately. In addition, you will need to keep a specific schedule of tests and appointments.

• I went home from the hospital in a week.
• See a cardiologist in about a month.
• Electrocardiogram (EKG) tests at 3, 6, and 12 months after surgery, and then once a year.
• A Holter monitor (a device that monitors heart activity for 24 hours) test at 6 and 12 months after surgery.

It is very important to have all these tests done correctly to ensure your health.