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Maze 3 for atrial fibrillation: two cuts too few?
S S Tsui1, A A Grace, P F Ludman
1Department of Cardiac Surgery, Papworth Hospital, Cambridge, United Kingdom.
Pacing and Clinical Electrophysiology : PACE
|November 1, 1994
Summary
A modified Maze 3 procedure for atrial fibrillation surgery recruits the isolated left atrial wall block, preventing potential fibrillation and thrombus formation. This surgical innovation promotes sustained sinus rhythm and effective atrial contractions post-operation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- The Maze 3 procedure treats atrial fibrillation but isolates a left atrial (LA) wall block, potentially causing continued fibrillation and thrombus.
- This isolated LA block, comprising 35% of the endocardial surface area and 29% of the weight, can harbor macroreentrant circuits.
Purpose of the Study:
- To modify the Maze 3 surgical technique to integrate the isolated LA block.
- To prevent potential electrical and mechanical dissociation within the LA post-Maze 3 surgery.
Main Methods:
- Surgical modification of the Maze 3 procedure with additional cuts to recruit the isolated LA block.
- Estimation of LA block size and weight in formalin-fixed human hearts.
Main Results:
- The modified Maze 3 procedure successfully recruited the isolated LA block.
- The first patient maintained sinus rhythm postoperatively and after burst atrial pacing.
- Atrial contractions contributed 19% of cardiac output.
Conclusions:
- The modified Maze 3 procedure effectively integrates the LA block, maintaining sinus rhythm and coordinated atrial function.
- This surgical refinement addresses a key limitation of the original Maze 3 technique, improving patient outcomes.