Maze Procedure

The Maze procedure is designed to stop the abnormal electrical signals that cause atrial fibrillation, or AFib.

During the procedure, a cardiac surgeon creates a series of carefully placed scar lines in the upper chambers of the heart, called the atria. Scar tissue does not conduct electrical signals. As the scars heal, they form a pathway, or "maze," that directs the heart's electrical activity along a controlled route and helps maintain a normal heart rhythm.

The Cox-Maze procedure

The Cox-Maze procedure is the most widely used surgical version of this treatment. Today's procedures often use energy sources such as radiofrequency or cryoablation rather than traditional surgical incisions to create the scar pattern.

During the procedure, a surgeon creates a specific pattern of lesions in the atria to interrupt abnormal electrical pathways while preserving the heart's normal electrical conduction system.

The Cox-Maze procedure is an open heart surgical operation.

Robotic Hybrid AF Convergent treatment

For selected patients with persistent or long-standing persistent AFib who do not otherwise need open heart surgery, UC Health also offers a different approach: robotic hybrid AF convergent treatment. The epicardial portion is performed robotically through small chest incisions and is combined with catheter-based endocardial ablation by electrophysiology. This coordinated approach expands minimally invasive treatment options for selected patients with persistent and long-standing persistent AFib.

Depending on a patient's needs, the Maze procedure may be performed:

• During another planned heart surgery, such as valve repair or replacement
• As a standalone open surgical procedure
• With surgical left atrial appendage closure when appropriate
• As part of a comprehensive AFib strategy coordinated between cardiac surgery and electrophysiology

A Maze procedure may be considered for people who:

• Have persistent or long-standing persistent AFib
• Continue to experience symptoms despite medication
• Have AFib that affects daily activities or quality of life
• Have not achieved desired results with catheter ablation or other treatments
• Need heart surgery for another condition, such as a valve disorder
• Have recurring AFib despite previous treatment

Because every patient's condition is different, treatment decisions are based on factors such as AFib type, symptom burden, overall heart health and treatment history.

For some patients, medication or catheter ablation may be the right choice. For others, an open Cox-Maze procedure may provide the best opportunity to improve heart rhythm and reduce symptoms. For selected patients who do not require open heart surgery, UC Health also offers a robotic hybrid AF convergent approach that combines robotic epicardial ablation with catheter-based endocardial ablation.

Before the procedure

Before surgery, you'll meet with members of your care team for a complete evaluation. This may include:

• A physical examination
• Electrocardiogram (ECG)
• Echocardiogram
• Cardiac imaging studies
• Blood tests
• Review of previous AFib treatments

Cardiac surgeons and electrophysiologists review this information together to determine whether a Maze procedure is the most appropriate treatment option.

During the procedure

The procedure is performed under general anesthesia.

The exact approach depends on your heart condition and whether the Maze procedure is being performed alone or during another heart surgery. Your surgeon creates carefully placed scar lines using specialized surgical tools or energy-based technology to block abnormal electrical signals.

In some cases, the left atrial appendage may also be treated or closed to help reduce stroke risk. Your surgeon will discuss whether this is appropriate for your situation.

After the procedure

After surgery, you'll spend time recovering in the hospital while your care team monitors your heart rhythm and overall health.

Recovery varies based on the type of procedure performed and whether additional heart surgery was completed at the same time.

Follow-up care may include:

• Heart rhythm monitoring
• Medication management
• Follow-up visits with your surgeon and electrophysiologist
• Cardiac rehabilitation, when appropriate

Your care team will provide guidance on activity restrictions, recovery expectations and long-term AFib management.

For appropriate candidates, a Maze procedure may:

• Improve heart rhythm control
• Reduce AFib symptoms such as fatigue, shortness of breath and heart palpitations
• Improve quality of life
• Lower the likelihood of recurrent atrial fibrillation
• Reduce dependence on certain heart rhythm medications in some patients
• Support long-term management of AFib

Results vary from person to person, and your physician can discuss expected outcomes based on your individual condition.

As with any heart procedure, the Maze procedure carries risks.

Potential risks may include:

• Bleeding
• Infection
• Stroke
• Blood clots
• Need for a pacemaker
• Heart rhythm changes
• Need for additional AFib treatment

Your care team will review potential benefits and risks with you before treatment.

Not every patient with AFib needs surgery.

At UC Health, patients have access to a full range of atrial fibrillation treatments, including:

• Lifestyle changes
• Heart rhythm and rate-control medications
• Cardioversion
• Catheter ablation
• Robotic hybrid AF convergent procedures
• Left atrial appendage occlusion, including robotic surgical closure when appropriate
•  Cox-Maze procedures

By bringing cardiac surgeons and electrophysiologists together, we can evaluate all available options and recommend the treatment that best fits your needs.

When you're living with atrial fibrillation, choosing the right treatment is just as important as choosing the right team.

At UC Health, heart rhythm specialists and cardiac surgeons work together to develop treatment plans based on your specific condition. Patients have access to both surgical and nonsurgical AFib treatments, including open Cox-Maze surgery and robotic hybrid AF convergent treatment, allowing our experts to recommend the most appropriate option rather than a one-size-fits-all approach.

With convenient online appointment scheduling and access to specialists across the region, getting started is simple. Call 513-475-8521.