Treatment of atrial fibrillation using the Maze procedure: the Japanese experience

The results of a questionnaire survey show that surgical treatment for atrial fibrillation (AF) has been performed in more than 2,500 patients in Japan. The methods of treatment used were the Cox-Maze-II procedure, the Cox-Maze-III procedure, the Kosakai-Maze procedure, the left atrial Maze procedure, the right atrial Maze procedure, compartment operation, radial operation, and other modifications. The success rates of the right atrial Maze procedure and compartment operation for AF associated with congenital heart disease were approximately 50%. These success rates were significantly lower than those of the other procedures (P < .005), which were more than 70%. Among the latter procedures, there was no significant difference in success rate. In the author's experience, atrial tachycardias caused by micro-re-entries or acceleration of automaticities were seen in approximately 50% of unsuccessful cases. Any type of Maze procedure can be used to cure atrial arrhythmia that is caused by macro-reentries alone. In the future it will be very important to establish indications for the Maze procedure and methods of simplifying the operation.