17086 Heart Surgery For Atrial Fibrillation Maze

Overview

Atrial fibrillation (AF) is an irregular, often fast heartbeat. The Maze procedure is a type of heart surgery used to help control AF. The surgeon makes a pattern of tiny scar lines in the heart, like a maze, to guide the heart's electrical signals so they travel in a more normal way. It is usually considered when AF is hard to control or when someone is already having other heart surgery.

AF is one of the most common heart rhythm problems, especially in older adults. Maze surgery itself is much less common and is done by specialist heart teams for selected patients.

AF is more common in older adults and in people with high blood pressure, heart valve disease, heart failure, obesity, sleep apnoea, diabetes, or thyroid problems. Maze surgery is considered for some people whose AF causes troublesome symptoms or who are having other heart surgery.

Symptoms

Common symptoms

• A fluttering, racing, or irregular heartbeat
• Tiredness or low energy
• Shortness of breath, especially with activity
• Dizziness or light-headedness
• Chest discomfort
• Feeling unable to exercise as much as usual
• No symptoms at all in some people

Symptoms in children

• AF is uncommon in children. A child with a fast or irregular heartbeat, fainting, chest pain, or poor feeding should be checked by a doctor.
• Children may not describe palpitations clearly, so watch for unusual tiredness, dizziness, or fainting.

Symptoms in older adults

• Symptoms can be vague, such as tiredness, breathlessness, dizziness, or falls.
• AF may first be noticed after a stroke or a routine pulse check.
• Older adults may also have other heart conditions that affect treatment choices.

Causes

Main causes

• Heart damage from high blood pressure, valve disease, heart failure, or a previous heart attack
• Age-related changes in the heart's electrical system
• An overactive thyroid gland
• Sleep apnoea, where breathing stops and starts during sleep
• Excess alcohol use
• Infection or stress on the body after surgery

Risk factors

• Older age
• High blood pressure
• Obesity
• Diabetes
• Sleep apnoea
• Heavy alcohol use
• Smoking
• Family history of AF
• Other heart conditions, such as valve disease or heart failure

When to see a doctor

See a doctor urgently if:

• Call your local emergency number for chest pain, fainting, stroke signs, or severe breathlessness.
• Contact your doctor or local health service the same day if you notice a new irregular heartbeat, worsening breathlessness, dizziness, or leg swelling.
• After heart surgery, seek urgent advice for fever, wound redness or drainage, heavy bleeding, or severe pain.

Book a routine appointment if:

• If you have known AF and your symptoms change
• For medication reviews and follow-up appointments
• If you notice palpitations that keep coming back
• Before planning pregnancy or surgery, ask your heart team about your AF treatment

Diagnosis

A doctor will ask about your symptoms, check your pulse, and usually do an ECG (a painless heart tracing). You may wear a heart monitor at home to catch irregular rhythms. Before maze surgery, the heart team does tests to see how your heart is working and to plan the operation.

Tests that may be done

• ECG (electrocardiogram) to record the heart's electrical signals
• Holter or event monitor to record the heartbeat over time
• Echocardiogram (ultrasound of the heart) to check heart structure and valves
• Blood tests, including thyroid and kidney tests
• Chest X-ray or other imaging
• Exercise test or stress test in some cases
• Heart catheterisation in some patients before surgery

What to expect at your appointment

Most tests are quick and painless. Before surgery, you will meet the heart team, including a cardiologist and a surgeon. They will explain the possible benefits, risks, recovery, and other treatment choices. Ask questions so you feel clear about what will happen.

Treatment

Treatment for AF aims to control the heart rate or rhythm, lower the risk of stroke, and improve symptoms. Options include healthy lifestyle changes, medicines, procedures to reset the heart rhythm, catheter ablation, and surgery. Maze surgery is one surgical option for selected people.

Self-care at home

• Take medicines exactly as your care team advises and do not stop them without asking.
• Check your pulse from time to time and note any irregular pattern.
• Keep all follow-up appointments and cardiac rehabilitation sessions.
• Follow wound care instructions carefully after surgery.
• Avoid smoking and limit alcohol.
• Manage blood pressure, weight, sleep apnoea, and diabetes with your healthcare team.

Medical treatments

Medicines may be used to slow a fast heart rate, keep the heart rhythm steadier, or lower the risk of stroke. Some people need blood-thinning medicines to reduce stroke risk. Procedures such as cardioversion or catheter ablation may also be tried. Your care team will choose based on your symptoms, age, heart health, stroke risk, and preferences. Do not start or stop any medicine without asking your clinician.

When is surgery considered?

Maze surgery may be offered if AF symptoms are hard to control with other treatments, if you are already having other heart surgery such as valve surgery or bypass, or if your heart team thinks it can help. It can be done in different ways depending on your needs. Ask your surgeon about the benefits, risks, recovery time, and whether it is right for you.

Living with this condition

Recovery from heart surgery takes time. You may feel tired for several weeks and need to build up activity slowly. Follow your wound care and rehabilitation plan, keep follow-up appointments, and ask your care team before driving, lifting heavy items, or returning to work.

Lifestyle tips

• Eat a heart-healthy diet rich in vegetables, fruit, whole grains, and lean protein.
• Stay active within the limits your care team gives you.
• Limit alcohol and avoid binge drinking.
• Stop smoking and avoid second-hand smoke.
• Keep blood pressure, cholesterol, weight, and blood sugar in a healthy range.
• Treat sleep apnoea if you have it.
• Manage stress and get regular sleep.

Diet and exercise

A heart-healthy diet and regular gentle activity can support recovery and heart health. Start slowly after surgery and follow your cardiac rehabilitation plan. Ask your team before starting vigorous exercise or heavy lifting.

Mental health and emotional wellbeing

AF and heart surgery can cause worry, low mood, or fear about the heartbeat. These feelings are common. Talk with your care team, family, or a counsellor. If you feel overwhelmed or have thoughts of self-harm, contact your local crisis support service or emergency services immediately.

Prevention

Not all AF can be prevented, but healthy habits can lower your risk and support heart health. This includes managing blood pressure, weight, sleep apnoea, diabetes, alcohol use, and smoking.

Vaccines

Ask your clinician about recommended vaccinations. Infections can be harder on people with heart conditions, and staying up to date can help protect you.

Screening programmes

Checking your pulse regularly can help you notice an irregular heartbeat. If you feel palpitations or an irregular pulse, ask your doctor about an ECG. People with high blood pressure or other heart risks should have regular check-ups.

Complications

If left untreated

• Higher risk of stroke
• Heart failure or worsening heart function
• Uncontrolled symptoms such as breathlessness and tiredness
• Blood clots
• Reduced quality of life and exercise tolerance
• Memory or thinking problems linked to AF in some people

Long-term outlook

Many people improve after maze surgery, with fewer AF episodes and better symptoms. Results vary, and some people still need medicines or other treatment. Your heart team will monitor you and adjust care as needed. Most people can live well with AF when it is managed carefully.

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