7 Surprising Facts About the Maze Procedure

  • Woman holding heart shape
    Maze Procedure Facts
    A maze procedure is one option for treating atrial fibrillation—or afib. It involves making tiny cuts in the heart muscle that scar as they heal. The scar tissue blocks the irregular electrical signals from traveling through the heart muscle and causing afib. It may be an option if you have symptomatic afib or if medicines aren’t controlling it. Here are some other facts you might not know about the maze procedure, including the mini-maze procedure.
  • Close-up of heart monitor with surgeons in background in operating room
    1. The maze procedure has been around for decades.
    Dr. James Cox developed the maze procedure back in the 1980s. It has a very high cure rate of more than 96% of patients remaining free of afib 10 years after surgery. However, it is a complicated and complex open heart surgery that involves cutting and sewing the heart muscle. As a result, few surgeons perform this original technique. It was originally called the Cox Maze procedure, “cut and sew” maze procedure, or Cox Maze III, as it was changed and perfected.
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    2. The maze procedure has evolved with time.
    The current version of the maze procedure uses an energy source, such as a laser, to make cuts in the heart muscle. It’s faster than a Cox Maze because the surgeon doesn’t need to sew the cuts. But it’s still an open heart surgery. So, doctors typically use this maze procedure for heart patients that also need open heart surgery for other reasons. Today, this type of surgery is called a full maze procedure or a Cox Maze IV.
  • team of surgeons during operation in operating theater
    3. There is a minimally invasive maze procedure.
    About one-third of afib patients don’t have other heart conditions and don’t need open heart surgery. For these patients, doctors have a minimally invasive version they can use. This ‘mini-maze’ procedure still uses an energy source to cut the heart muscle, but it doesn’t require opening the chest. It works best for people with intermittent (paroxysmal) afib. However, doctors may still consider it if you have long-standing (persistent) afib. There’s still a chance it will be successful.
  • cardiologist inserting guide wire into catheter into patient during surgery or medical procedure
    4. There is also a hybrid maze procedure and catheter ablation.
    One of the newest developments in the maze procedure is combining it with a catheter ablation. In this hybrid procedure, the catheter ablation treats the inside of the heart and the maze surgery treats the outside. This dual approach offers a more effective option for people with hard-to-treat persistent afib. It’s still relatively new and not all heart centers can do the hybrid procedure. It’s still an active area of research to identify the safest and most effective way to perform it. You may also see it called hybrid ablation.
  • happy African American father son and grandfather on hike
    5. Maze procedures have a high success rate.
    The full maze procedure afib cure rate is 80 to 95%. This means it is able to stop afib and prevent stroke without the use of anticoagulants. The mini-maze procedure has a comparable success rate in people with intermittent afib. It is successful in up to 90% of these patients. For people with longstanding afib, the success rate isn’t quite as high. But it is still able to help up to 75% of people with this type of afib.
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    6. You can be back on your feet within a few days after a mini-maze procedure.
    Recovery after a maze procedure can be long, especially with a full maze procedure. Because it’s open heart surgery, both the ICU stay and the overall hospital stay is longer than for a mini-maze. With a mini-maze, most people can return to normal activities, including work, within a few days. Full recovery from a full maze procedure can take 8 to 12 weeks. A cardiac rehabilitation—or rehab—program can help you recover safely.
  • doctor using digital tablet to talk to a senior male patient about electrocardiogram tracing
    7. You can still have afib after a maze procedure.
    About half of people undergoing a maze procedure will have short episodes of afib during recovery. It’s mostly due to swelling in the heart muscle. As you recover and the swelling goes away, these bouts of afib should subside. In the meantime, you may need medicines to control your heart rhythm and prevent blood clots. Usually, this is only necessary for about three months. A small number of people will continue to have afib after three months.
7 Surprising Facts About the Maze Procedure

About The Author

Sarah Lewis is a pharmacist and a medical writer with over 25 years of experience in various areas of pharmacy practice. Sarah holds a Bachelor of Science in Pharmacy degree from West Virginia University and a Doctor of Pharmacy degree from Massachusetts College of Pharmacy. She completed Pharmacy Practice Residency training at the University of Pittsburgh/VA Pittsburgh Healthcare System. 
  1. Are You a Candidate for a Maze Procedure? StopAfib. https://www.stopafib.org/maze-candidate.cfm
  2. Are You a Candidate for Mini Maze? StopAfib. https://www.stopafib.org/mini-maze-candidate.cfm
  3. Atrial Fibrillation Surgery. Johns Hopkins University. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/atrial-fibrillation-surgery
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  5. Heart Surgery for Atrial Fibrillation (MAZE). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17086-heart-surgery-for-atrial-fibrillation-maze
  6. Hybrid Surgical-Catheter Ablation. Stanford University. https://stanfordhealthcare.org/medical-treatments/h/hybrid-surgical-catheter-ablation.html
  7. Jiang YQ, Tian Y, Zeng LJ, et al. The safety and efficacy of hybrid ablation for the treatment of atrial fibrillation: A meta-analysis. PLoS One. 2018;13(1):e0190170.
  8. Maze Procedure. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/maze-procedure/pyc-20384973
  9. Maze Procedure Success Rates. StopAfib. https://www.stopafib.org/maze-success-rates.cfm
  10. Maze Procedure (Surgical Ablation). StopAfib. https://www.stopafib.org/surgical-ablation.cfm
  11. Mini Maze Procedure Success Rates. StopAfib. https://www.stopafib.org/mini-maze-success-rates.cfm
  12. Mini Maze Procedure (Surgical Ablation). StopAfib. https://www.stopafib.org/mini-maze.cfm
  13. What to Expect After a Maze Procedure. StopAfib. https://www.stopafib.org/maze-expect-after.cfm
  14. What to Expect After Mini Maze Surgery. StopAfib. https://www.stopafib.org/recovering.cfm
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jun 25
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