What Is the MAZE Procedure for AFib?
MAZE is a cardiac surgery procedure to treat AFib. During a MAZE procedure, your surgeon will make several incisions on the left and right atriums of your heart to form scar tissue. The scar tissue will block the abnormal electrical signals that cause AFib.
Benefits of MAZE procedures for AFib include:
- Allows many people to safely go off long-term blood-thinning drugs.
- Allows surgeons to block off the heart's left atrial appendage — the area of the heart where potentially stroke-causing blood clots can form — during the same procedure.
Is the MAZE procedure the same as an ablation?
MAZE and ablation are both minimally invasive procedures to treat AFib. However, the two procedures are different.
The MAZE procedure creates scarring on the outside of the heart and is performed through small incisions in the chest. An ablation creates scarring on the inside of the heart and is performed through a small incision in the groin using a catheter.
A procedure called a hybrid ablation combines parts of MAZE and ablation. During a hybrid ablation, and electrophysiologist and cardiac surgeon will:
- Make a few small incisions in your chest and insert instruments to perform the surgical procedure on the outside of your heart.
- Insert a catheter into a blood vessel and guide it to the inside of your heart.
- Use heat or cold to destroy small amounts of tissue, creating scars that block abnormal electrical signals on both the inside and outside of your heart.
Types of MAZE procedures for AFib
There are three types of MAZE procedures for AFib:
- Open MAZE surgery — An open-heart procedure. That means your surgeon will open your chest to perform the procedure.
- Minimally invasive MAZE surgery — Also known as thoracoscopic MAZE, performed through small incisions in the chest wall using a small camera and video-guided surgical instruments. This procedure doesn't involve opening your chest or using a heart-lung bypass machine. The result is often a shorter recovery time and a lower risk of infection when compared to open-heart surgery.
- Concomitant MAZE surgery — Performed at the same time as an open-heart bypass surgery or valve surgery.
Conditions we treat with MAZE
Why Would I Need MAZE?
If you have severe AFib that hasn’t responded to other treatments, the experts at UPMC may suggest MAZE surgery.
Who’s a candidate for MAZE?
You may be a candidate for MAZE if:
- Less invasive AFIB treatments haven't worked.
- You have changes to your heart's structure — such as enlarged heart chambers or a leaking valve.
- You need another type of open cardiac surgery, such as coronary artery bypass graft (CABG) or valve surgery.
Alternatives to MAZE
What Are the Risks and Complications of MAZE?
The MAZE procedure is safe and effective, but as with any surgical procedure, rare complications can occur. Risks include:
- Anesthesia complications.
- Bleeding at the incision site.
- Blood clots, stroke, or heart attack.
- Heart rhythm problems.
- Infection.
What Should I Expect From MAZE?
Before: How to prepare for MAZE
Your doctor will explain the MAZE procedure to you and give you a chance to ask questions. To prepare for a MAZE procedure, you should:
- Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
- Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
- Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure.
- Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
- Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
- Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.
On the day of your MAZE procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.
Your doctor will tell you how long you need to stay in the hospital after your MAZE procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes.
How long does MAZE take?
MAZE procedures take 2-4 hours, depending on whether you are having a minimally invasive MAZE or an open MAZE procedure. If you are having another cardiac surgery procedure at the same time, your MAZE procedure may take longer.
During your MAZE procedure
Your MAZE procedure will be performed under general anesthesia. You will receive medications through an IV to put you to sleep.
How is the MAZE procedure performed?
During the procedure, your cardiac surgeon will make one or more incisions in your chest. Your surgeon will then make small cuts on the surface of the left and right atriums of your heart. When these small cuts heal, they will form scar tissue.
Because the scar tissue does not conduct electricity, it will disrupt the path of the electrical signals that cause your abnormal heart rhythm. The scar tissue also prevents abnormal electrical signals from recurring.
After the incisions are made, your atrium is sewn together to allow it to hold blood and contract to push blood into your ventricle.
Recovery after MAZE
You will be taken to the recovery room for observation or returned to your hospital room where a nurse will monitor your vital signs. The length of your hospital stay will depend on whether you had an open or concomitant MAZE or a minimally invasive MAZE.
Because minimally invasive MAZE procedures are less invasive than concomitant or open MAZE procedures, patients who have minimally invasive MAZE procedures usually have a shorter hospital stay.
How long does it take to recover from a MAZE procedure?
You may feel sore and tired for several weeks after your MAZE procedure. The length of your recovery will depend on whether you had a minimally invasive MAZE procedure or an open/concomitant MAZE procedure. Recovery time is generally shorter for patients who have had a minimally invasive MAZE procedure.
If you had an open or concomitant MAZE procedure, complete recovery may take 6-8 weeks. Minimally invasive MAZE procedure recovery time is around 4-6 weeks. Your doctor will let you know when you can return to your normal activities and will schedule you for a follow-up appointment after your procedure.
When to call your doctor about complications
You should call your doctor if you are experiencing any unusual symptoms, including:
- A fever of more than 100.0°F.
- Burning or pain in your chest.
- Difficulty breathing.
- Difficulty swallowing, throat pain, or bloody cough.
- New or increasing shortness of breath.
- Pain, redness, bleeding, drainage, or increased swelling at the incision site.
- Rapid or pounding heartbeat.
- Redness or rash on your chest or back.
What’s the prognosis after MAZE?
After a MAZE procedure, most patients experience a complete resolution of AFib symptoms. However, some patients need to continue taking medications to control their heart rhythm. In some people, AFib symptoms may return in the future.
What is the survival rate for MAZE surgery?
MAZE is a safe procedure when performed by cardiac surgery experts. The survival rate for MAZE procedures is greater than 98 percent, even for patients who are having other high-risk cardiac procedures at the same time.
What’s the success rate of MAZE?
MAZE has been shown to be 90 percent effective at maintaining a normal heartbeat without the use of any anti-arrhythmic medications a full year after the surgery for all types of AFib.
Why Choose UPMC for MAZE?
UPMC cardiac surgeons are at the forefront of developing MAZE techniques that can improve patient outcomes and shorten recovery time. Our surgeons can perform MAZE procedures during other complex open surgical procedures.
UPMC is one of only a few medical centers in the nation to offer minimally invasive total thoracoscopic MAZE, which combines the MAZE procedure with advanced mapping techniques to provide increased surgical precision and improved patient outcomes.
Last reviewed by a UPMC medical professional on 2024-10-01.