What is the Difference Between a Maze Procedure and an Ablation for Afib?

It is believed that about 5 million American adults have a condition commonly known as Afib, or atrial fibrillation, according to the American Heart Association.

By 2030, that number is expected to rise to 12 million. Those numbers are of major concern because Afib is a common cause of stroke. 

When medications and other treatments aren't enough to restore a normal heart rhythm, your doctor may recommend a procedure called cardiac ablation. 

How ablation works?

Ablation works by creating small areas of scar tissue in precise locations inside the heart. Scar tissue doesn't carry electrical signals. By placing those scars in the right spots, doctors can block the abnormal electrical activity that causes AFib and help the heart return to a normal rhythm.

There are two main ways to create these scars: catheter ablation and the maze procedure. Both approaches have the same goal, but they differ in how they're done and when doctors recommend them.

What is catheter ablation?

Catheter ablation is a minimally invasive procedure. That means no large incisions and a shorter recovery compared to open-heart surgery.

During the procedure, a doctor threads a thin, flexible tube called a catheter through a blood vessel, usually in the groin, and guides it to the heart. Once in place, the catheter delivers energy to create small, targeted scars that block the problem signals. Most patients go home within a day or two.

This approach is often the first surgical option considered when AFib is the primary concern and other treatments haven't worked.

What is the maze procedure? 

A maze procedure is another way to create scar tissue that blocks the abnormal electrical signals that cause AFib. Doctors often do this during open-heart surgery when a patient is already having surgery for another heart problem. If AFib is the only reason for surgery, doctors can use minimally invasive techniques to perform a maze procedure. 

One benefit of a surgical maze is that it gives the surgeon a chance to remove or close off the left atrial appendage, a small pouch in the upper left chamber of the heart. This pouch does not control the heart’s rhythm, but it plays an important role in stroke risk. About 90% of the blood clots that cause stroke in people with AFib form in the left atrial appendage. Removing or closing it can reduce stroke risk by about 90%, even if the patient continues to have AFib.

During a maze procedure, a surgeon uses heat or cold energy or a scalpel to create a mazelike pattern of scars on the small areas of heart tissue causing the irregular heartbeats.  

After the surgery, scar tissue blocks the abnormal electrical signals, which allows the normal signals to control the heart rhythm. 

Why is it called a maze procedure?  

Maze might sound like an abbreviation or an acronym but it’s not. Instead, it describes the detailed maze of scar tissue created by the surgery.

It was developed in the late 1980s and early 1990s by Dr. James Cox, an American cardiothoracic surgeon. It is sometimes referred to as the Cox maze procedure. 

What is the recovery time for maze surgery?

Maze surgery is considered open heart surgery. After the surgery, patients typically spend a day or two in the intensive care unit, followed by a few more days in a regular hospital room. Patients having a minimally invasive maze have shorter hospital times.

Full recovery takes six to eight weeks, or less if minimally invasive. Temporary episodes of Afib can occur during the first few months after surgery as the scarred tissues begins to heal.

Check-ups with the surgeon are usually scheduled for one week and one month after leaving the hospital.

Can Afib come back after a maze procedure?

Yes, Afib can recur. Studies indicate that Maze surgery has a long-term success rate of roughly 85%.  

According to guidelines from the American Heart Association, recurrences often fall into the following timelines and categories:  

1. Temporary post-op flare (zero to three months): About 30% to 50% of patients experience short AFib episodes while the heart heals and scar tissue forms. This typically subsides on its own or with temporary medication.
2. Late and very late recurrence (one to five years or more): AFib can return years later. This is often due to tissue reconnection (where the surgical lines didn't hold perfectly) or underlying structural changes to the heart over time. 

Maze procedure versus ablation

Simply put, catheter or cardiac ablation is a minimally invasive procedure used to treat heart rhythm disorders by destroying the tiny areas of heart tissue that are causing the irregular beats.

Maze procedure is open-heart surgery during which a surgeon creates a pattern of scar tissue in the atria to disrupt the abnormal electrical signals.

Most experts believe neither procedure is considered universally better. The best option often depends on the severity of the patient’s AFib and other factors such as the individual’s overall health.  

Cardiac ablation is far less invasive than maze surgery, thus making recovery time shorter.

However, many medical experts believe the maze procedure has a higher long-term success rate than cardiac ablation. 

What are the long-term effects of the maze procedure?

The Journal of Thoracic and Cardiovascular Surgery points to studies indicating the maze procedure has an excellent long-term efficacy at maintaining a patient’s proper heart rhythm.

The journal reported that follow up studies suggested the maze surgery remained superior to those reported for catheter ablation and other forms of surgical ablation for Afib.