According to the American Heart Association, over 2 million people in the U.S. suffer from atrial fibrillation (AF or AFib). This is a condition in which your heart s electrical system malfunctions and produces an erratic heartbeat. Electrical signals from your sinoatrial node spread across the surface of the organ s two upper chambers (atria) in a disorganized pattern. This causes the atria to fibrillate.
AFib can cause blood to accumulate within the atria, which introduces a risk of blood clots. If the blood clots exit through the left ventricle, they can move toward your brain and set off a stroke.
Atrial fibrillation can be addressed surgically with the maze procedure. A surgeon will make incisions or lesions across the heart s upper chambers in order to produce scar tissue. The scarred tissue cannot conduct electricity. That allows the surgeon to create a uniform path along which the electrical impulses are forced to travel. Below, you ll discover the various forms of the operation as it has evolved over the past two decades.
Cox Maze
In 1987, the maze procedure was first performed by Dr. James Cox. At the time, the operation could only be accomplished through open surgery. It was highly invasive and required the patient s heart to be stopped. Moreover, the operation posed a number of significant risks as well as a long recovery period. As such, it was usually reserved for situations in which the patient was already undergoing some other type of open heart surgery.
Since then, the Cox Maze has evolved. The tools are better and the techniques used are less complex. Instead of incisions, surgeons can use a variety of energy sources to ablate the atrial tissue. While still rare, patients can undergo the operation without already being scheduled for a concurrent open surgical procedure.
Minimaze
The main challenge of the original Cox procedure was that the patient s heart had to be arrested. Minimaze or minimally invasive maze was developed to resolve this issue. It focused on producing the atrial scar tissue from outside the organ (or, epicardially). This allowed the surgeon to perform the operation without stopping the patient s heart.
The incisions used during the Cox method were replaced by lesions generated through microwave energy. Shortly after this strategy debuted, radiofrequency energy was adopted. Today, the minimaze can be performed with a number of different energy sources.
Cryomaze
One of the most recent developments in resolving atrial fibrillation through maze surgery is the creation of Cryomaze. Rather than using microwave, radiofrequency, ultrasound, and other energy sources, to produce the necessary heat to ablate the atrial tissue, Cryomaze uses a cold probe to freeze the tissue. By freezing areas of the atria for a short period (i.e. 60 to 90 seconds), the surgeon can permanently block the disorganized spread of the electrical impulses. This method is still being tested and is only performed in a small number of surgical centers.
Mild atrial fibrillation may not require treatment, especially if symptoms are absent. However, if you suffer from severe AFib, ask your doctor whether maze surgery (in any form) is appropriate for your circumstances.
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