Your Heart, Atrial Fibrillation, And the Maze Procedure

by Elizabeth Lynette Perkins

Posted on Monday 25th of July 2011

Your heart works continuously to make sure blood is oxygenated and circulated to the organs and tissues throughout your body. To do this, the four chambers (atria and ventricles) contract in a uniform manner consistent with your heartbeat. As each chamber contracts, the blood within moves outward to other chambers, your lungs, or into the aorta.

Your heartbeat is caused by electrical signals that are generated by the sinoatrial node. This node is a special cluster of cells located near the top of your right atrium. Emanating from this cluster, each signal travels downward in an organized pattern, spreading across the surface of the atria and causing them to contract.

The signal then arrives at another cluster of cells called the atrioventricular node. It is located between the left and right ventricles. The signal pauses for a moment to allow the lower chambers to fill with blood before spreading across the surface of the ventricles. As it travels, it causes the lower chambers to contract.

This process normally occurs between sixty and one hundred times each minute. However, problems with your heart's electrical system can prevent the chambers from contracting properly and thus, affect your heart's ability to pump blood to the rest of your body. One such problem is atrial fibrillation.

Atrial Fibrillation Explained

Atrial fibrillation (or Afib) is an arrhythmia. It is caused by a disruption of the electrical signals that spread throughout the atria and ventricles. Rather than originating from the sinoatrial node, they begin somewhere else in the atria, or in the left pulmonary veins. Moreover, instead of spreading across the surface of the atria in a uniform manner, they do so erratically and cause them to flutter.

With Afib, the atrioventricular node is flooded with abnormal electrical signals. This accelerates the contractions in the ventricles, but not as quickly as those in the atria. As a result, the atria and ventricles fall out of sync.

One of the side effects of atrial fibrillation is that the atria fail to push all of their blood outward. Because of this, the ventricles cannot fill completely before contracting, which limits the amount of blood available to the rest of your body. Meanwhile, blood is allowed to pool within the upper chambers, a circumstances that can lead to clots.

How Maze Surgery Corrects The Problem

Atrial fibrillation can be resolved with the Maze procedure. A surgeon uses an ablation device to create scar tissue in both atria. This scar tissue serves as a conduction block that herds the electrical signals along a carefully-planned pathway. By creating this pathway, the surgeon can coordinate the contractions of the atria and ventricles. This allows them to work together efficiently in moving blood from the upper chambers to the lower ones.

Years ago, the Maze procedure was performed after making a long incision into the patient's chest and splitting his or her breastbone. The patient's heart was arrested during the operation. Today, most Maze surgeries are done with a minimally invasive approach. The ablation device is used to create the necessary conduction block through a small incision made into the side of the patient's chest. If performed this way, the entire procedure can usually be completed within a few hours.

Not all cases of Afib need to be treated with surgery. Much depends on the severity of your symptoms and the risk of complications. For example, clots that form as the result of blood pooling in the left atrium can potentially travel to your brain and cause a stroke. Also, if your heart becomes unable to pump a sufficient amount of blood to your body, you might suffer heart failure. Both circumstances may warrant surgery.

If you suffer from atrial fibrillation, speak with your doctor or a thoracic specialist regarding whether the Maze procedure is an option. If it is, ask whether a minimally invasive approach can be taken.

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