The Maze Operation for Treatment of Atrial Fibrillation

The Maze operation is a potentially curative surgical option in patients with disabling atrial fibrillation (AF) refractory to conventional treatment. The aim of this study was to evaluate the initial 4-year Maze experience in our institution. The study included 26 patients (19 males, mean age 55 years) who had undergone the Maze (III) operation between 1994 and 1998. Nine patients had surgery for concomitant heart disease. Follow-up was 3‐55 (median 18) months. No deaths or neurological complications occurred; 22 patients are at present in regular sinus-, or junctional rhythm, 2 patients have permanent atrial pacing for symptomatic sinus node dysfunction, and 2 patients have had persistent AF, post surgery. Sinus node dysfunctions were detected in five patients, though not requiring pacemakers. Out of the total 26 patients, 23 are free of anti-arrhythmic drugs. Echocardiographic signs of left atrial contraction were recorded in 50% of the patients. The Maze operation offers a safe alternative to conventional therapy, with attractive results justifying expansion in the use of this treatment for AF. Atrial fibrillation (AF) is the most common type of arrhythmia, with a prevalence of 0.5‐1% in the general population and up to 10% among the elderly (1). AF is usually associated with various cardiovascular disorders such as valvular heart disease, myocardial infarction, congestive heart failure and hypertension. Frequently, however, the disorder is idiopatic in origin, occurring as a lone entity, especially in patients with paroxysmal AF. Furthermore, AF is associated with an increased mortality, mainly due to the elevated risk of thromboembolism and stroke, and many of these patients require life-long anticoagulant treatment. Stroke in connection with AF causes more severe neurological symptoms and has a higher mortality rate than stroke without AF (2). Cardiac output is often reduced in patients with AF because of the fast, irregular heart rate and the absence of atrial systole. Conventional treatment of AF has been restricted to pharmacological therapy and catheterbased His bundle ablation. In 1987, James Cox introduced the Maze operation as an open heart surgical treatment of AF after extensive animal- and human studies of arrhythmia mechanisms (3‐5). At present, the Maze procedure is fairly widespread internationally for treatment of patients with symptomatic paroxysmal or chronic AF, refractory to anti-arrhythmic drug therapy or in cases of intolerance to these drugs. The procedure is performed either as a sole arrhythmia operation or increasingly in combination with other procedures, performed simultaneously. Follow-up studies by Cox and others have shown excellent results, with a very high incidence of restored sinus rhythm and atrioventricular synchronization (6‐14). In addition, return of atrial contraction is considered to be of great importance in reducing the risk of local thrombus formation. By restoring these three functions, the Maze operation has been put forward as a curative method for all deleterious effects of AF, which is in contrast to conventional therapy (6). Furthermore, a successful Maze operation will potentially end the patient’s need for anti-arrhythmic and anticoagulant treatment. Experience of the Maze operation has not previously been reported from Scandinavia, and the aim of the present study was to evaluate the results of the first 26 patients operated on by this method at our institution during a 4-year period.