Purpose: Maze surgery is performed in the following cases:

• Medications for atrial fibrillation cannot be tolerated, or medications are ineffective for treating atrial fibrillation
• Inability to take blood-thinning medications like warfarin
• You are at a high risk of having a stroke (a condition in which the blood supply to the brain is obstructed) or have a history of stroke.

Symptoms: The following symptoms may be seen in case of atrial fibrillation, and may require a maze surgery if other treatment options fail:

• Palpitations (fast, pounding, or fluttering heartbeat)
• Chest pain
• Fatigue
• Dizziness
• Lightheadedness
• Shortness of breath
• Weakness
• Decrease in ability to exercise

The following diagnostic tests may be performed before a maze surgery:

1. Physical examination: The doctor examines the patient physically and looks for signs and symptoms of atrial fibrillation. The patient’s medical history and family history are noted by the doctor.
2. Blood tests and urine tests: These tests are done to check for medical conditions or infections that may cause atrial fibrillation.
3. Chest x-ray: It helps in evaluating the condition of the patient’s heart and lungs.
4. Stress test: This test is performed to record the response of a person while performing certain physical exercises, like walking on a treadmill.
5. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart.
6. Holter monitor: This is a kind of portable ECG that is to be worn by the patient for 24 hours. The electrical activity of the heart for 24 hours can be obtained using this device.
7. Event recorder: This is also a kind of portable ECG used to monitor the activity of the heart over a period of a few weeks to months. Whenever the patient experiences the symptoms of fast heartbeats, a button is pressed to activate the monitor.
8. Echocardiogram: Sound waves are used in this type of ultrasound to obtain detailed images of the heart in motion.

The maze surgery procedure is normally performed under general anesthesia (the patient is unconscious during the procedure).
The maze surgery procedure can be performed in one of the following ways:
1. Mini-maze surgery:

• Small keyhole incisions or cuts are made by the surgeon in the chest area.
• An endoscope and certain special surgical instruments are inserted by the surgeon through these incisions.
• The endoscope helps the surgeon to view the inside of the chest while performing the surgical procedure.
• Heat energy or cold energy is then used to make scar tissue on the heart.
• The heart is still beating while performing this procedure.
• The incisions are then closed by the surgeon by sutures (stitches).
• The procedure has is less painful and has a rapid recovery compared to open surgery.
• The procedure can also be performed as robotic-assisted surgery, in which the robotic arms are controlled by the surgeon through a monitor while performing the procedure.

2. Open-heart surgery:

• When an individual has another heart disease along with atrial fibrillation, the surgeon may perform a maze surgery during open-heart surgery.
• The surgeon makes a large incision or cut in front of the chest and then separates the breastbone.
• The patient is connected to a heart-lung bypass machine, which does the work of the heart and lungs during the surgery. The heart is stopped during the procedure.
• Heat energy or cold energy is used to make scar lines in the right and left atria of the heart (upper chambers of the heart).
• The heart-lung bypass machine is then removed.
• The breastbone is wired back together by the surgeon, and the incision is closed using sutures.

The risks associated with a maze surgery are:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to anesthesia
• Heart attack
• Kidney failure (waste and fluid buildup in the body due to improper functioning of the kidney)
• New arrhythmias (irregular heart rhythms)
• Stroke
• Requirement of a permanent pacemaker (a device implanted in the body to treat arrhythmias)
• Death

• It is normal to have some discomfort and soreness after the maze surgery.
• The doctor may recommend pain-relieving medications to relieve the pain.
• A breathing tube may be placed in the patient’s throat to help the patient breathe. This tube is usually removed two days after the procedure.
• A tube may be placed in the chest area for the drainage of extra fluids. This tube is also removed two days after the procedure.
• The vital parameters of the patient are constantly monitored in the hospital.
• The patient is taught breathing exercises to help in removing the fluids that get accumulated in the lungs during the procedure.
• The patient is initially kept on a liquid diet, and gradually progressed to normal food.
• The patient stays in the hospital for two to three days after a mini-maze surgery, and five to ten days after open-heart surgery.
• The patient is asked to avoid heavy lifting for some weeks after the surgery.
• The sutures are removed by the surgeon 7 to 14 days after the surgery.
• The doctor will give you instructions about medications, diet, exercise, and wound care for quick recovery.
• Complete recovery after maze surgery may take approximately two to three months.