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J Thorac Cardiovasc Surg 1995;110:473-484
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATIONI. Rationale and surgical results

James L. Cox, MD, John P. Boineau, MD, Richard B. Schuessler, PhD, Robert D. B. Jaquiss, MD, Demetrios G. Lappas, MD


St. Louis, Mo.

Supported by National Institutes of Health grant Nos. RO1 HL32257 and RO1 HL33722.

Received for publication Sept. 27, 1994. Accepted for publication Dec. 14, 1994. Address for reprints: James L. Cox, MD, Evarts A. Graham, Professor of Surgery, Vice-Chairman, Department of Surgery, Chief, Division of Cardiothoracic Surgery, Suite 3108, Queeny Tower, One Barnes Hospital Plaza, St. Louis, MO 63110.

Abstract

The original maze procedure that was described for the treatment of patients with atrial fibrillation was followed by an unacceptable incidence of two problems: (1) the frequent inability to generate an appropriate sinus tachycardia in response to maximal exercise and (2) occasional left atrial dysfunction. In an effort to overcome these problems, we modified the original technique (maze I) twice. The results of these modifications culminated in the maze III procedure, which is associated with a higher incidence of postoperative sinus rhythm, improved long-term sinus node function, fewer pacemaker requirements, less arrhythmia recurrence, and improved long-term atrial transport function. In addition, the maze III procedure is technically less demanding than either the maze I or maze II procedure. Therefore, the maze III procedure is now the technique of choice for the management of medically refractory atrial fibrillation. (J THORAC CARDIOVASC SURG 1995;110:473-84)




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