The standard Maze-III procedure

A total of 299 patients have undergone the Maze-III procedure in our unit. Thirty-eight percent of all patients experienced temporary perioperative atrial fibrillation within the first 3 months after surgery. These early postoperative arrhythmias invariably responded to routine medical therapy, and they had no correlation with long-term results of the surgery. Overall, only 4 of 346 patients who have had any type of Maze procedure still have atrial fibrillation, a failure rate of 1.2%. One of the commonly repeated misconceptions regarding the Maze procedure is that the surgery itself damages the sinus node mechanism and causes patients to need pacemakers postoperatively. Overall, only 15% of the patients required new pacemakers after surgery. Indeed, 123 patients who underwent the Maze procedure alone were documented to have normal sinus node function preoperatively, and not one of those patients needed a permanent pacemaker after the Maze procedure. Thus, it is clear that the Maze procedure itself does not cause the patient to need a pacemaker after surgery. Another common misconception is that the atria do not function after the Maze procedure. In our series, all patients were documented to have both right atrial and left atrial transport function in the immediate postoperative period that contributed to forward cardiac output. On late follow-up evaluation, various tests were used to determine whether or not either or both atria were contracting. These tests included dynamic MRI scanning, AV pacing versus ventricular pacing, transthoracic echocardiography, and transesophageal echocardiography. Using one or more of these tests, 98% of patients were documented to have right atrial transport function and 93% of patients were documented to have left atrial transport function after the Maze-III procedure.