Talking With Your Doctor About the Maze Procedure
Until now, you may have been trying to manage afib with medicines. This is the initial approach to afib treatment, but medicines don't always work. And sometimes, people can’t tolerate them. If you find yourself in either of these situations, having a maze procedure may be an option. One of the major maze procedure benefits is being able to prevent blood clots and stroke without anticoagulants. But the procedure isn’t right for everyone. Here are some tips to get started and specific questions you may want to discuss with your doctor.
Before you meet with your doctor (your maze surgeon), it’s a good idea to prepare for the conversation; that way, the appointment will be more focused and likely to give you the answers you need. Consider these steps:
- Do your research. If you have access to the internet, research the types of maze procedures.
- Write down your goals; for instance, afib symptom control without medicine.
- Make a list of concerns and questions, such as recovery time for the maze procedure.
- Don’t go alone. A second set of eyes and ears can be helpful when you are processing a lot of information. Afterwards, you can review the information together with your friend or family member.
There are two basic types of procedures for afib. A maze procedure is one option, but it isn’t the only one. The other possibility is a catheter ablation, or cardiac ablation. It is the least invasive of the two basic options because it isn’t surgery like a maze procedure. Instead, it uses a catheter your doctor inserts through a tiny incision, usually in the groin. Not everyone is a candidate for this less invasive procedure. But it’s worth asking your doctor about it. Follow-up questions include:
- Why do you recommend the maze procedure vs. catheter ablation for my afib?
- What are the specific pros and cons of each procedure?
- How effective are each of the procedures for long-term afib symptom control?
- Will I still need to take afib or other heart medicine after the procedure?
A maze procedure isn’t just one type of surgery. There are two basic versions. The first is a full maze procedure, which is the gold standard. For this version, the maze procedure steps involve opening the chest. This makes it the most invasive option. It’s usually preferred for people who already need heart surgery for other problems.
The other type of surgery is a mini-maze. There are several versions of this minimally invasive surgery. Most afib patients are candidates for this type of maze procedure. And a mini-maze has a comparable success rate in the right patients. Ask your doctor about the best choice for you and your specific type of afib.
Additional questions might include:
- What pre-op testing do I need, and where is it done? (This is especially important if you don’t live close to the maze surgical facility. Consider coordinating with a medical facility closer to your home for all your pre-op testing.)
- Are there certain test results that would cancel or postpone the surgery?
Most maze procedures are a success and heal without complications. However, there are potential risks with any surgery. This includes bleeding, infection, and blood clots. There are also specific maze procedure risks you should consider. In a small percentage of people, the surgery uncovers a problem with a slow heart rate, for which a pacemaker may be necessary. So, it’s another important point to discuss with your surgeon and cardiologist.
With all maze procedures, it’s possible to have short periods of afib in the first three months afterwards. Your doctor may need to prescribe medicines to manage your heart rhythm and prevent blood clots. This is usually temporary and you’ll be able to stop the medicines once the issue resolves. Ask your doctor about these and other complications and how often he or she encounters them.
In general, maze procedures have a very high success rate: Up to 95% of patients undergoing a full maze procedure will not have afib long-term. It is an effective way to prevent stroke without the use of anticoagulants. But even mini-maze procedures are highly effective in treating afib for the right patients. People with paroxysmal—or intermittent afib—have the highest success rates with the mini maze. While the success rate drops for people with persistent afib, it may still stop afib in about 3 in 4 patients (75%).
Your doctor should be able to share his or her outcomes data for people with your type of afib. Ask how often your doctor sees a return of afib in patients like you.
Since a full maze procedure is an open heart surgery, the recovery will be different than after a mini-maze. A full maze surgery will involve a longer hospital stay and longer time in the ICU (intensive care unit). The risk of complications during recovery will also be different. It will likely take longer to get back to feeling like yourself again, as well. These things aren’t necessarily bad if a full maze is the best choice for your health. But you do need to understand what you’re in for so you can prepare.
Additional questions may include:
- How long will I be in the hospital?
- Will I need someone to care for me at home while I recuperate from surgery? How do I arrange that?
- What kind of medicine do you prescribe for pain control?
- When will I be able to go back to work?
- When can I start exercising again? What type of exercise is best as I recover?
- Is cardiac rehabilitation right for me?
- Do you recommend cardiac ‘prehabilitation’ for me? (Prehabilitation is a program to help people physically prepare for heart surgery, which may impact your recovery.)
- What is the typical full recovery time for the procedure I’m having?
- What should I do if I experience afib once I’m home from the hospital? When should I call you or your office, during and after hours?
You will see your doctor regularly in the year after a maze procedure. In the weeks right after the surgery, you’ll need follow-up to make sure you’re healing properly. But your doctor will also monitor your heart closely. You will need an EKG (electrocardiogram) at one, three, six and 12 months after surgery. Some doctors also use a Holter monitor so they can see your heart’s rhythm over a longer period. Ask your doctor about the follow-up studies you will need and how often you will need them.
It may seem like a lot of questions, but it’s important to get to a point where you understand completely what is going to happen and what your life might be like while you recover and after the procedure.