The maze III procedure for atrial fibrillation: Should the indications be expanded?

Background. We favor the maze III procedure over nonsurgical treatments for atrial fibrillation and have advocated addition of the maze in symptomatic patients with other compelling indications for cardiac surgery. Methods. Characteristics and perioperative outcomes of our 76 cumulative ma ze recipients between 1993 to 1998 were reviewed. The original maze III tec hnique was employed without modification. Results. Isolated maze III was performed in 19 patients (25%) and combined with other procedures in 57 patients (75%), 49 of these involving one or mo re valves. Patients having combined procedures were taking fewer antiarrhyt hmics (p < 0.0001), but were older (p < 0.01), more often female (p < 0.05) , and more often had chronic atrial fibrillation (p < 0.01) compared with i solated maze III recipients. The mean duration of aortic clamping and cardi opulmonary bypass for isolated maze was 69 +/- 11 and 145 +/- 22 minutes, a nd for combined valve procedures it was 122 +/- 38 and 205 +/- 47 minutes. There was no operative mortality. Complications occurred in 15 patients (19 .7%). At 3 months atrial fibrillation was cured in 73 of 75 patients (97.3% ). Sick sinus syndrome required pacemaker implantation in 3 patients (4.0%) . Conclusions. The maze III can be performed alone or as a combined procedure with equivalent success, and technical modifications may be unnecessary. A lower threshold for its expanded use in symptomatic patients with atrial f ibrillation who require isolated or combined operations is appropriate. (An n Thorac Surg 2000;70:1580-6) (C) 2000 by The Society of Thoracic Surgeons.