ObjectiveThe authors analyzed the clinical results during the first 81k years' experience with the Maze procedure for the surgical treatment of atrial fibrillation. Summary Background DataAtrial fibrillation occurs in 0.4% to 2% of the general population and in approximately 10% of patients older than 60 years of age. ft is associated with significant morbidity and mortality. The irregular heartbeat causes discomfort, the loss of synchronous atroventrcular contraction compromises hemodynamics, and the stasis of blood flow increases the vulnerability to thromboembolism. Methods ResultsNinety-three percent of all patients were arrhythmia free without any antiarrhythmic medication. Of the remaining patients with arrhythmia recurrence, all were converted to sinus rhythm with medical therapy. All patients were documented to have atrial transport function by either direct visualization, transesophageal echocardiography, or atrioventricular versus ventricular pacing at the same rate. Ninety-eight percent had documented right atrial function, and 94% had left atrial function. Of the 107 patients in this series who were documented to have a normal sinus node preoperatively, only 1 patient required a permanent pacemaker. ConclusionThe Maze procedure is an effective treatment for medically refractory atrial fibrillation in properly selected patients. 267

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The original maze procedure that was described for the treatment of patients with atrial fibrillation was followed by an unacceptable incidence of two problems: (1) the frequent inability to generate an appropriate sinus tachycardia in response to maximal exercise and (2) occasional left atrial dysfunction. In an effort to overcome these problems, we modified the original technique (maze I) twice. The results of these modifications culminated in the maze III procedure, which is associated with a higher incidence of postoperative sinus rhythm, improved long-term sinus node function, fewer pacemaker requirements, less arrhythmia recurrence, and improved long-term atrial transport function. In addition, the maze III procedure is technically less demanding than either the maze I or maze II procedure. Therefore, the maze III procedure is now the technique of choice for the management of medically refractory atrial fibrillation.

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