Management (surgical)

Surgical interventions

The Maze procedure

It consists of creating incisions in the atrium that disrupt the re-entrant circuits which are then sewn together again. This results in the blood still being able to be pushed into the ventricle from the atrium but the electrical impulse cannot cross the incisions. Thus there is only one pathway that the electrical impulse can travel from SA node to the AV node. The atrium can no longer fibrillate, and sinus rhythm (the normal rhythm of the heart) is restored.

Indications
It is not required for most patients with atrial fibrillation as either
- they are not bothered by the rhythm
- the medications used are able to control it
- catheters can be used to disrupt the circuits

Surgery is only required if patients feel troubled by the atrial fibrillation or the convenience of not having to take medications. Patients with atrial fibrillation who suffered stroke before are advised to undergo surgery as their risk for another stroke is higher.

Risk
As it is an "open heart" procedure requiring cardiopulmonary bypass (the heart-lung machine) there are risks of fluid retention, pneumonia, stroke, kidney failure, other organ failure and death. Some patients also require a permanent pacemaker postoperatively. This is thought to be due to underlying disease of the SA node.

Results
It is highly effective in restoring sinus rhythm but it is around 80-100%