Do you also have irregular heartbeats? Let's learn more about the Maze Procedure for Atrial Fibrillation!

Have you ever felt your heart beating very fast and irregularly? This condition, which feels like something is fluttering in your chest, is medically known as Atrial Fibrillation. When this cannot be controlled with medication, we are talking about a somewhat complicated but very effective treatment method that is used as a solution. That is the Maze Procedure.

What is this Maze Procedure?

Simply put, it's like a maze. You may have played with mazes when you were a kid, where you enter through one door and have to take only one correct path to get out. This surgery is similar.

Our heart beats are controlled by electrical signals. In atrial fibrillation, the electrical signals in the two upper chambers of the heart, called the atria, become erratic and start to send out incorrect signals. The heart then starts to beat erratically.

In the Maze Procedure, the surgeon creates scar tissue in a very delicate, planned pattern in the atria of the heart. This scar tissue acts like a barrier, stopping the wrong electrical signals from traveling throughout the heart. However, it leaves a path for only the correct signals needed for the heart to beat properly. Just like there is only one correct path in that maze. This allows the heart to beat normally again.

Two methods are used to create this scar tissue:

• Cryoablation: Inactivation of tissue using extreme cold (freezing).
• Radiofrequency Ablation: Heating of tissue using high heat (radio waves).

This surgery can be done as a separate surgery, or it can be done at the same time as bypass surgery or heart valve surgery.

Why is this Maze Procedure being done?

This surgery is not recommended for everyone. There are several situations in which your doctor may suggest this treatment:

• If the medications prescribed for atrial fibrillation are not working for you or you have side effects that prevent you from taking them.
• If this condition has caused blood clots to form in your body and serious conditions such as stroke have occurred .
• If you are undergoing other heart surgery (e.g. bypass, valve replacement) and you also have atrial fibrillation.
• If previous treatments such as `(Catheter Ablation)` have not been successful.

What happens before and during the surgery?

Since this is a major surgery, you will be examined carefully before it begins.

Two methods of surgery

There are two main methods of surgery. Your medical team will decide which method is best for you.

1. Open Surgery (Sternotomy Method): In this method, the surgery is performed through a 6-8 inch incision along the middle of the chest bone.

2. Minimally invasive surgery (Thoracoscopic Method): In this method, instead of a large incision in the chest, several small incisions are made between the ribs and a camera and delicate instruments are inserted. The recovery time is shorter in this method.

Left Atrial Appendage Removal

Another very important part of this surgery is the closure or removal of a small part called the Left Atrial Appendage . This is a small, ear-shaped pouch that is attached to the left atrium of the heart.

It has been found that 90% of blood clots that cause strokes in patients with atrial fibrillation form in this small sac . Because the heart does not beat properly, blood accumulates in this area and clots. If this blood clot breaks free and travels to the brain, a stroke occurs. So, during Maze surgery, this area is closed with stitches, staples, or a special device. This can significantly reduce the risk of stroke.

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 had minimally invasive surgery (thoracoscopic), you will be able to go home in about 4 days. If you had open surgery, you will be in the hospital for about a week.

You will still have to take several types of medication for several months after you go home.

• Blood thinners (Anticoagulants): You will need to take medications like `Warfarin` or `Apixaban` for at least 3 months to prevent blood clots. After that, your doctor will decide if you need to continue taking them.
• Heart rate control medication: To control irregular heartbeats that may occur during the early stages of heart recovery.
• Diuretics: Reduce unnecessary fluid accumulation in the body.

What are the benefits and risks of this surgery?

How long does it take to heal and when should I see the doctor again?

It usually takes between 3 and 6 weeks to return to your normal activities. If the surgery was performed using a minimally invasive technique, the recovery time is much shorter.

After surgery, you will need to see the doctor on a scheduled schedule.

• A week after leaving the hospital.
• A month after leaving the hospital (cardiologist).
• ECG tests at 3, 6, and 12 months.
• A `Holter Monitor` (a device that monitors the heartbeat for 24 hours) test at 6 and 12 months.

It is essential for your well-being to attend all of these tests and appointments.

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