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Updated: Feb 9, 2026

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
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The Maze Procedure and Postoperative Pacemakers.

James L Cox1, Niv Ad2, Andrei Churyla1

  • 1Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

The Annals of Thoracic Surgery
|June 9, 2018
PubMed
Summary

Right atrial lesions in the maze procedure rarely cause patients to need pacemakers. Other factors, such as unmasked sick sinus syndrome or surgical complications, are more common reasons for pacemaker implantation after maze surgery.

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Area of Science:

  • Cardiac Surgery
  • Electrophysiology
  • Atrial Fibrillation Management

Background:

  • Concerns exist regarding maze procedure's right atrial lesions potentially increasing permanent pacemaker needs.
  • The therapeutic advantage of right atrial lesions over left atrial lesions alone is questioned.

Purpose of the Study:

  • To investigate the relationship between maze procedure atrial lesions and postoperative pacemaker requirements.
  • To identify factors contributing to pacemaker necessity after maze surgery.

Main Methods:

  • Discussion of atrial fibrillation anatomy and maze procedure techniques.
  • Analysis of potential conduction system damage and non-procedure-related causes for pacemaker use.
  • Review of preoperative factors affecting sinoatrial node function.

Main Results:

  • Reasons for pacemaker implantation include successful maze surgery unmasking sick sinus syndrome.
  • Excessive dissection, temporary arrhythmias, surgical errors, and patient selection also contribute.
  • Right atrial lesions are seldom identified as the cause for pacemaker necessity.

Conclusions:

  • The right atrial lesions of the maze procedure are rarely, if ever, the cause of new permanent pacemaker requirements.
  • Multiple factors contribute to pacemaker use post-maze surgery, distinct from the atrial lesions themselves.