MAZE OPERATION - A SURGICAL-PROCEDURE FOR CHRONIC ATRIAL-FIBRILLATION

The maze operation is a newly developed surgical procedure for patient s with chronic atrial fibrillation. Between may 1993 and october 1994, 11 patients underwent mitral valve surgery combined with the maze pro cedure, 10 for chronic, medically refractory, symptomatic atrial fibri llation and 1 for intermittent, symptomatic atrial flutter. In one pat ient, a double aorto-coronary venous bypass was added. The operative m ortality was 9%: one patient died on the 7th postoperative day from a perioperative cerebrovascular accident. Postoperatively, electrophysio logical and stress testing as well as transthoracic or transesophageal echocardiography (TTE; TEE) were performed. All patients were in sinu s rhythm. Left and right atrial contractions were analyzed by TTE/TEE and the atrial transportfunction was documented in each patient. The p ostoperative exercise stress test revealed slight sinus-node incompete nce. After a mean follow-up time of 10.4+/-5.4 months (1 to 16 months) all surviving patients are free from atrial fibrillation or flutter a nd without need for medication. The maze operation, which we performed for the first time in connection with mitral valve surgery, is a succ essful treatment for chronic, medically refractory atrial fibrillation and intermittent, symptomatic atrial flutter. This procedure provides a sinus rhythm with atrioventricular synchrony, restores the atrial t ransport function and obviates the need for antiarrhythmic drugs. Long -term anticoagulation appears unnecessary.