MAZE Procedure with AVR surgery

[JeffM]

Has anyone had any experience with this procedure designed to eliminate atrial fibrillation?. My cardiologist recommended it. He feels that there's a good chance the AFib episodes, which just started as my numbers have deteriorated over the last 6 months, will dissipate with the new valve. However, he also suggests that it would be prudent to ablate the neurolgical pathways while I'm open. It will add some time (not sure how much) to my time on the heart/lung machine. Any thoughts?

 

[kfay]

I had a modified right side maze procedure in April with my tricuspid replacement. I haven't had any episodes of a-flutter/a-fib since. I was on amiodarone for about 2 months after my surgery which probably helped keep any at bay as well.

Kim

 

[Adrienne]

I had a left maze which was done by radio frequency. I had A-Fib in August 2005. I was also told that it would probably go away with the repair of my mitral valve, but the surgeon thought it was a good idea to do the Maze, just as your cardiologist thinks. I have been in normal sinus rhythm ever since (with a few PVCs and PACs from time to time the first year especially).

 

[JeffM]

Glad to hear you're both doing well. Very encouraging.

 

[Cooker]

I had ablation along with my AVR ... I believe it is the same thing ... It worked ... 2.5 years and no a-fib ...Good luck!!!

 

[ALCapshaw2]

Not all surgeons perform the MAZE procedure so be sure to discuss that option with him.

Many of us have had good results using SOTALOL (generic form of BetaPace) to keep A-Fib at bay.

 

[JeffM]

Not all surgeons perform the MAZE procedure so be sure to discuss that option with him.

Many of us have had good results using SOTALOL (generic form of BetaPace) to keep A-Fib at bay.

More encouraging reports thanks. Al, thank you for the heads up. Fairfax hospital supposedly has a pretty good electrophysiologist whom, I presume, would participate in the surgery with the valve surgeon. I will ask how he intends to work it in though. Good to know there is an effective way to control a-fib with drugs as well.

 

[67walkon]

Jeff, sorry, I just saw this. I had a maze with AVR and aneurism repair, all in July, 2007. It went great for me, but I did have a bit of trouble finding a doc who had done all those procedures.

John

 

[Scooby06]

Hey all,
The new guidelines for surgeons state that all pts undergoing open heart surgery and not contraindicated be ablated.

 

[Adrienne]

Hey all,
The new guidelines for surgeons state that all pts undergoing open heart surgery and not contraindicated be ablated.

Even patients that have no rhythm problems with their heart???!!!

 

[JeffM]

I'm ignorant as to the application of "contraindicated" in this situation . Can you explain?

Also, some time ago I read that those on betablockers pre-op were more likely to develop arrhythmia post-op. I believe it was related to anesthesia somehow. Have you ever heard of that?

[edit - Here was what I read some time ago: http://www.rxlist.com/cgi/generic/betapaceaf_wcp.htm

"Anesthesia

The management of patients undergoing major surgery who are being treated with beta-blockers is controversial. Protracted severe hypotension and difficulty in restoring and maintaining normal cardiac rhythm after anesthesia have been reported in patients receiving beta-blockers."]

I did get a partial MAZE "left pulmonary block" with my AVR. So far, so good. I'm on Amiodarone, Coumadin, Metoprolal and Enalapril Maleate (ACE inhibitor). The first three weeks I was getting skipped beats and occasional arrythmias in which my HR would shoot up to the 90 - 100 range (not too concerning, I was told). Now, I'm just getting occasional skipped beats. Hopefully, that progress will continue and I'll be able to get off of these meds in another 6 weeks.

 

[Adrienne]

Adrienne- Scooby06 is partially right. If they are having heart surgery and the patient has AF they will do ablation if it contains minimal risk but usually only if the patient is symptomatic. If they don't have rhythm issues, then definitely not. Also, these are just recommendations and it is still highly up to the cardiologist, surgeon, and patient whether that would be the best option. In addition, not all people agree that this is the best approach.

I see from your profile that your occupation is pediatric cardiology. Although most members here are not children, that still makes you pretty much of an expert on the subject of heart surgery.

So, my question to you is, in your opinion, seeing that I had A-Fib in August 2005 which led to the beginning of CHF, and seeing that I went to the ER, got cardioverted and then was given Amiodarone and other meds which kept me stable and in sinus rhythm until my surgery which was Oct. 20, 2005, was it the right decision for my surgeon to do the left Maze? I have certainly never regretted it as I have been in sinus rhythm ever since, but I am just curious as to your opinion.

 

[kfay]

Adrienne, I didn't really have any symptoms of a-fib, but agreed to go ahead with the maze during surgery. It wasn't until after I was home and de-drugged that I really looked into it deeply and had a momentary feeling of regret in agreeing to it. Just looking at the pattern and how much cutting they do to your heart kind of freaked me out. However, I know in the long run I'll be glad I had it done because people with my anomaly can have significant rhythm issues as we age.

Kim

 

[Adrienne]

Thanks UIHCCHI.

Kim, you mentioned all the cutting they do. Mine was done by radio frequency, not by a scalpel. Actually, I have no idea which is better, but I have read that the maze by radio frequency is much quicker.

 

[Susan in Texas]

Maze survivor

Maze survivor

Seeing how you had symptoms of AF, if it was low-risk (which I'm assuming it was), they might as well take an effort to try to permanently stop AF seeing how they were in there for the MV repair. Many factors go into deciding the best treatment option and I'm not sure exactly how much trouble you had with AF so I can't give you a real detailed answer but success rates for MAZE are generally excellent, as it has been so far for you.

I had the Maze proceedure pulmonary vein isolation in Dec'04 for a-fib. During this robotic proceedure, my phrenic nreve was damaged to the point my right diaphram was paralized for the 14 months it took to recover. I thought there was no cutting too, till this happened and I was told how. The sack or bag around my heart had to be opened to allow the robot to place the cath around the heart and burn it's scars by radio or micro frequency. I was told it was during this opening which was cut and then retracted open for the robotic hands to do their thing that the phrenic nerve was either nicked, pulled, jerked or just pulled to it's limit and caused it to "Stroke".

 

[Susan in Texas]

Back in a-fib post Maze

Back in a-fib post Maze

I did want to say that after 3 years of limited spurts of a-fib, It has caught back up with me, and brought SVT along with it. My spells are longer, and more frequent. I'm back on meds again, and very leary of any "proceedure".

 

[Bridgette]

Seeing how you had symptoms of AF, if it was low-risk (which I'm assuming it was), they might as well take an effort to try to permanently stop AF seeing how they were in there for the MV repair. Many factors go into deciding the best treatment option and I'm not sure exactly how much trouble you had with AF so I can't give you a real detailed answer but success rates for MAZE are generally excellent, as it has been so far for you.

I was told that the success rates for the Maze are not 90-95% like you see quoted on the internet, but more in the range of 75%.

 

[Adrienne]

I was told that the success rates for the Maze are not 90-95% like you see quoted on the internet, but more in the range of 75%.

My surgeon told me about the same percentage (maybe 70%).

 

[JeffM]

I've read and heard that while minimally and non-invasive Maze procedures are far less traumatic overall, they also limit access, maneuverability and visibility. Further, the surgeon is relying on something other than his/her hands and so the risk of adjacent tissue damage is greater. In fact, I heard someone discussing this on NPR yesterday about surgeries in general. It's only been 9.5 weeks since my AVR and pulmonary vein isolation but at this point I'm having no rhythm problems. I am on 100mg of Amiodarone, which is a pretty low dose. My fingers are crossed that my a-fib won't start up again when I go off this stuff in about a month.

 

[notneb1970]

HI all,

Many times with Maze procedures they do not cut they use cryo ablations or in some cases radio ablations. Depends on the surgeon, facility and the patient's anatomy and symptoms.
My husband had a PVR, Multifestered ASD bovine patch (due to a possible EPS back in 2001), and a modified Maze procedure in July of 2008.
He never had A FIB or A Flutter but had PSVT's sometimes as high 300 bpm that were usually convertible with the valsomanuever. He had to cardioverted when he was younger with Verapmil and Adenosine.
Since surgery he has had a few episodes where he thought that his heart was going to go into a full blown PSVT but it never has. He still has mild PVC's and PAC's occasionally, but then almost everyone has them at times.
He still is on metoprolol, amino, enapril. He doesn't take his meds as directed....and now his heart rate has been hanging around 100 bpm.
I work in a ICU and have been told that many times the cure rate with the Maze procedure is 90 + % but it varies.
Hope this helps.....it is a tough decision.