- AFib that persists after optimal treatment with medications
- Unsuccessful catheter ablation
- Blood clots in the left atrium
- History of stroke
- Enlarged left atrium
- Other conditions requiring heart surgery
During the Maze procedure, a series of precise incisions or lesions are made in the right and left atria to confine the electrical impulses to defined pathways to reach the AV node. These incisions prevent the abnormal impulses from affecting the atria and causing AFib. The surgical Maze procedure can be performed traditionally with a technique in which precise surgical scars are created in the atria. It may also be performed using newer technologies designed to create lines of conduction block with radiofrequency, microwave, laser, ultrasound or cryothermy (freezing). With these techniques, lesions and ultimately scar tissue is created to block the abnormal electrical impulses from being conducted through the heart and to promote the normal conduction of impulses through the proper pathway. Many of these approaches can be performed with minimally invasive (endoscopic or “keyhole”) surgical techniques. Your doctor will talk with you about the procedure that is best for you based on your medical condition. If a patient has AFib and requires surgery to treat other heart problems (such as valve disease or coronary artery disease), the surgeon may perform the surgical treatment for AFib at the same time. Virtually all surgical approaches include excision or exclusion of the atrial appendage. The left atrial appendage is a small, ear-shaped tissue flap located in the left atrium. This tissue is a potential source of blood clots in patients who have atrial fibrillation. During surgical procedures to treat AFib, the left atrial appendage is removed and the tissue is closed with a special stapling device.