Maze surgery for the treatment of atrial fibrillation:

Atrial Fibrillation causes abnormally rapid heartbeat rhythm. In patients with atrial fibrillation, the normal cycle of electrical impulses in the upper chambers of the heart (atria) is interrupted causing a rapid, chaotic heart rhythm that is out of sync with the lower chambers of the heart (ventricles). It leads to poor blood movement from the upper heart chambers (atria) to the lower heart chambers (the ventricles). However, atrial fibrillation itself is not a life-threatening medical condition. If not treated in time it may cause blood clot formation in the heart and can lead to serious medical conditions like a stroke, heart failure, or other heart conditions. A Maze procedure is a heart surgery for the treatment of Atrial fibrillation (Afib). In Maze Surgery, heart surgeons work on creating a specific pattern ( MAZE ) of scar tissues that block the abnormal electrical impulses in upper heart chambers but allow the normal electrical impulses to come through. The Maze surgery in India offers a high success rate of 80 - 90 % for the treatment of atrial fibrillation. Get Maze surgery cost in India with the top Heart surgeons.

Types of Atrial Fibrillation:

Atrial Fibrillation can be broadly classified as:

• Paroxysmal or occasional Atrial Fibrillation patients may have symptoms that come and go without any treatment. Duration of symptoms may last for a few minutes to a few hours. In some patients, the symptoms may last for even a week. The episodes may be repeated but usually go away on their own. A few of the patients with paroxysmal atrial fibrillation may require medical treatment.
• In Patients with Persistent atrial fibrillation, the symptoms will not go away on their own. The symptoms may last for weeks and the irregular heartbeats persist. The heart rhythm does not reset on its own. In this type of Atrial Fibrillation, the patients will need medical treatments.
• Long-standing and persistent atrial fibrillation patients have irregular heartbeats that are constant and last longer than a year. These patients require medications or a procedure like Maza surgery to correct cardiac arrhythmias.
• Permanent atrial fibrillation patients require constant medications to control their heart rate and prevent blood clots as their heartbeat rhythm can not be reset.

Etiology of Atrial Fibrillation:

The human heart has two upper chambers (atria) and two lower chambers (ventricles). The two heart nodes comprise a special type of tissue that functions as muscles and nerve tissues. The two heart nodes are responsible for cardiac conduction or the electrical impulses that power the normal cardiac cycle:

1. The sinoatrial or sinus (SA) node is located in the upper wall of the heart's upper right chamber (atrium ). It is also referred to as the pacemaker of the heart. The sinus node coordinates atrial contractions. The nerve impulses generated by the SA node travel throughout the heart walls and make the two upper chambers (atria) contract. During exercise or performing a strenuous task, the SA node increases the heart pumping rate to deliver more oxygenated blood to muscles at a more rapid rate. In the resting phase, the heart pumping rate is normalized.
2. The Atrioventricular (AV) node is located on the right side of the partition, separating the two upper chambers of the heart. It is near the bottom of the right upper chamber of the heart. The Impulses generated by the SA node are delayed by 1/10th of a second in reaching the AV node. This delay allows the contraction of the upper heart chambers to empty the blood into the lower heart chambers before the lower chambers contract. The regulation of the electrical impulses by the AV node makes sure that they do not move too rapidly and cause atrial fibrillation. 

In atrial fibrillation, the upper chambers of the heart (atria) beats irregularly and very rapidly. Atrial fibrillation may cause blood clots in the heart and subsequently a stroke or even heart failure.

Epidemiology of Atrial Fibrillation:

Many researchers have attributed atrial fibrillation as a " New cardiovascular disease epidemic of the 21st century". Atrial fibrillation is a common heart disease condition among elderly people.

• More than 46.3 million people above the age of 55 years have been estimated to have atrial fibrillation globally.
• In the United States of America around 3 to 6 million people are estimated to have Afib and the figure is estimated to be doubled in the next decade.
• In Europe, more than 9 million people are estimated to have atrial fibrillation, and an alarming rise is forecasted.
• It is estimated that by 2060, 72 million Asians will develop Afib and around 3 million will suffer from Afib-related strokes.
• Although people of European origin stand a higher risk of Afib, however, black people with Afib are more prone to Afib-related serious complications like a stroke or heart failure.
• Women are more prone to Afib than men.

Symptoms of Atrial Fibrillation:

Some atrial fibrillation patients do not experience any symptoms unless the lower chambers of the heart (the ventricles) beat at a rapid pace. Patients with irregular heart rhythm (arrhythmia ) may experience the below-mentioned symptoms:

• An irregular or rapid heartbeat (palpitation)
• Chest pain (angina)
• Dizziness or feeling lightheaded
• Shortness of breath(Dyspnea)
• Feeling tired for no apparent reason ( extreme fatigue)
• Falling unconscious ( syncope )

Although Atrial fibrillation does not pose any serious threat, it can lead to serious life-threatening medical conditions like a stroke, heart failure, or other serious heart disorders.

Factors responsible for atrial fibrillation:

Normal aging is thought to be the major risk factor for atrial fibrillation. People above 65 years of age are at a higher risk of developing atrial fibrillation. Other identified risk factors for atrial fibrillation are:

• High blood pressure is a major cause of atrial fibrillation. One out of every five people having hypertension may develop atrial fibrillation (Afib)
• Living a sedentary lifestyle (not being physically active) or being overweight (obesity) is also a factor
• Patients having Type II diabetes stand higher chances of developing Afib
• Congenital heart disease also increases the risk for Afib
• Coronary artery disease (CAD) is a risk factor
• Overactive thyroid (hyperthyroidism) is a risk factor for Afib
• Sleep apnea is a risk factor for Afib
• Chronic obstructive pulmonary disease (COPD) - a lung disease
• Survivors of heart failure are at a higher risk of Afib
• Substance abuse like smoking, alcohol consumption, and recreational drug usage

Diagnosis of Atrial Fibrillation:

Once the treating doctor suspects atrial fibrillation in a patient, he will refer the patient to a cardiologist. A cardiologist will take a detailed medical and family history of the patient along with the following investigations to confirm the diagnosis:

• Blood tests to look for the overall health of the patient including thyroid function test, kidney function test, liver function tests, etc.
• ECG and EKG help in measuring the electrical activity of the heart. ECG can point out the irregular heart rhythm and is considered an important test for diagnosing atrial fibrillation.
• Holter Monitor test is conducted by asking the patient to wear a portable ECG recorder for one or two days to record the heart rhythm while the patient is doing all his core activities.
• Event recorder 
• Implantable loop recorder
• Echocardiocram
• Stress echocardiogram
• Chest Xray

Treatments for atrial fibrillation (Afib):

Once the atrial fibrillation diagnosis is confirmed the cardiologist will discuss the treatment plans for the patients with them. The objectives of treatments for atrial fibrillation are:

• Controlling the erratic heart rate
• Resetting a normal heart rhythm
• Reducing the risk of stroke
• Reducing the risk of cardiac complications

Treatment for atrial fibrillation depends on the following factors:

• What is the Duration of atrial fibrillation 
• What are the symptoms felt by the patient
• What are the causes of atrial fibrillation in a patient

There are generally three treatment modalities for correction of Atrial fibrillation.

Medical management:

Medical management of Atrial fibrillation involves medications for controlling the heart rate and heart rhythm, and prevention of the forming of blood clots to avoid stroke. 

Cardioversion therapy:

When the symptoms of atrial fibrillation are troubling the patient and it is the first episode of Afib, the treating cardiologists may try to reset the heart rhythm through cardioversion therapy. The cardioversion can be done either through drug cardioversion or through electrical cardioversion.

Surgery or catheter procedures:

At times medical management and cardioversion therapies are not able to bring relief to patients with atrial fibrillation. The treating doctors' team adopts another approach of cardiac ablation for the treatment of atrial fibrillation (Afib). 

Cardiac Ablation is generally performed by an interventional cardiologist in a cardiac catheter laboratory of a heart hospital. In cardiac ablation, the interventional cardiologist reaches the heart by putting a catheter through a blood vessel, usually the femoral artery in the groin region. Sensors at the end of the catheter apply cold or heat energy to create scar tissues in the heart chambers. These scar tissues of heart chambers disrupt the irregular heart pulses and allow only the regular heart impulses to restore the normal heart rhythm.

The Maze procedure or Maze surgery is done on the specific symptoms of atrial fibrillation, the overall health of the patient, and if any other heart surgery is planned like a heart valve repair/replacement or coronary artery bypass graft (CABG). 

The various types of cardiac ablation for the treatment of Afib are:

• Atrioventricular node (AV) ablation
• Pulse field ablation 
• Hybrid atrial fibrillation ablation

Maze procedure or Maze Surgery:

Maze surgery or Cox maze procedure is a heart surgery that treats atrial fibrillation or arrhythmias. In maze surgery, heart surgeons create scar tissues in the upper chambers of the heart ( the atria) in a maze pattern that blocks the abnormal heart impulses but allows the normal heart impulses to pass through and restore normal cardiac rhythm. A Maze surgery derives its name from a maze game that allows only one-way entry and one-way exit from the same pathway. 

Maze surgery can be done as a stand-alone therapy or simultaneously with another heart surgery like a heart valve repair/replacement or bypass heart surgery. Maze surgery is also performed when catheter ablation does not provide relief to an atrial fibrillation patient.

Maze surgery is an open heart surgery done by a CVTS doctor under general anesthesia and by using the heart-lung bypass machine. Best Heart surgeons in India use two approaches for performing maze surgery:

Sternotomy approach for maze procedure:

In the sternotomy approach, the heart surgeon makes a vertical cut through the breastbone to reach the heart. Several tiny slices are made in the atrium with a scalpal during a Cox-Maze procedure, and the atrium is subsequently stitched back together. These scars created by these incisions prevent the electrical signal from the heart from passing through. The aberrant signals that are produced in the atria no longer travel through the sliced region. As a result, the heart will stop fibrillating, and the abnormal heart rhythm return to normalcy.

Thoracoscopic approach: 

The thoracoscopic approach is the minimally invasive approach to reaching the heart for performing the maze procedure. In this approach for performing maze surgery, heart surgeons reach the heart by making incisions in between the ribs. It can be done as a robot-assisted maze surgery too. In the thoracoscopic approach for maze surgery, the surgeon uses cryosurgery ( using extremely cold substances like liquid nitrogen, even carbon dioxide or argan can also be used) or radiofrequency energy (extreme heat) to create scar tissues in the upper chambers of the heart (The atria). These scar tissues prevent the abnormal heart impulses generated in the atria from passing through to the ventricles (lower heart chambers), only normal heart rhythm prevails.

The Cox-maze IV procedure is the latest version of maze surgery and is considered a gold standard for the treatment of atrial fibrillation (Afib).

Removing or closing the left atrial appendage:

The left atrial appendage is a small, ear-shaped tissue flap located in the left upper heart chamber (left atria). Research has shown that 90% of blood clots are formed in the left atrial appendage. Blood can stuck into it and atrial fibrillation will cause the formation of blood clots. When a blood clot gets detached it can come into blood bloodstream and may cause a stroke in atrial fibrillation patients. Closing or removing the left atrial appendage will reduce the risk of stroke in Afib patients. While performing a maze procedure either through the surgery or a minimally invasive procedure in the left atrium the heart surgeon may either remove the left atrial appendage or close it with stitches, staples, or a special device to not allow blood to enter into it thus preventing any blood clot formation.

The need for maze surgery or Cox-Maze IV procedure:

Maze surgery or Cox-maze IV procedure is performed by a heart surgeon to treat atrial fibrillation and an irregular rapid heart rhythm. Atrial fibrillation doubles the risk of death due to congestive heart failure in a cardiac arrhythmia patient. 

Maze surgery or cox-maze IV procedure is a heart surgery performed by a cardiac surgeon for the treatment of:

• Atrial fibrillation
• Regulating the normal heart rhythm ( treating the arrhythmia)
• Prevention of blood clot in left atria  appendage
• Prevention of a stroke due to Afib
• Prevention of congestive heart failure

Care after the maze surgery or cox-maze IV procedure:

Usually, the patients remain in the cardiac ICU for 1-2 days under close observation for heart function and rhythm. After the cardiac ICU stay, the patient will stay another 3-5 days in the normal hospital room for follow-up and cardiac rehabilitation. The patients who have undergone the minimally invasive maze procedure will be discharged from the hospital after 4-5 days of surgery, while those who have undergone open heart surgery will stay in the hospital for around a week. 

At the time of discharge, the treating doctor team will advise the patient about the surgical wound care and will also prescribe the following medications:

• Blood thinners or anticoagulation medication for at least three months
• Medicines to control heartbeats
• Diuretics to control fluid retention

Special dos and don'ts post maze surgery:

1. Avoid lifting heavy objects for a few weeks
2. Following the recovery instructions, medications, exercise, and diet and resuming normal activities
3. Coming the the hospital OPD of the cardiac surgeon after 7-10 days, to monitor the progress and removal of the stitches 
4. If you notice any signs of infections at the surgical wound site, immediately come to hospital

If on follow-up visits your doctor feels that your heartbeats have become too slow after the maze procedure, you may be advised about implanting a pacemaker.

Maze surgery or Cox-maze IV procedure cost in India:

The Maze surgery or Cox-Maze IV procedure in India depends on the following factors:

1. Type of maze surgery ( open heart, minimally invasive, or robot-assisted)
2. The room category selected post the ICU hospital stay
3. Overall hospital stay
4. Hospital and expertise of heart surgeon
5. The cost of another heart surgery ( like a CABG or valve repair/replacement surgery) performed simultaneously with the maze procedure

The average cost of maze surgery or cox-maze IV procedure in India is as follows:

Please Note:

• The above-mentioned maze surgery or cox-maze IV procedure cost in India is just an estimation, it may differ on physical examination and initial workup investigation outcomes.
• The cost estimation may differ if any complications management is done during the procedure for overstay of the patient in the hospital.
• The cost of any other heart surgery performed along with the maze procedure will be charged extra.
• Any implant or additional procedure that is not part of the standard maze procedure will be charged separately.

The 5 Best Doctors for Maze Procedure in India:

Maze surgery is performed by an expert cardiovascular thoracic surgeon. We are associated with the best CVTS heart surgeons in India for a cost-effective Maze surgery or Cox-maze IV procedure in India for atrial fibrillation patients. The best Doctors for maze surgery in India are:

• Dr. Yugal Mishra, CVTS surgeon at Manipal Hospital, New Delhi, India.
• Dr. Z. S. Meherwal, CVTS surgeon at Fortis escorts Heart Institute, New Delhi, India.
• Dr. Anil Bhan, CVTS surgeon at Medanta-The medicity Hospital, Gurugram, India.
• Dr. Rajneesh Malhotra, CVTS surgeon at Max Super Specialty Hospital, New Delhi, India.
• Dr. Bhabha Nanda Das, CVTS surgeon at Indraprastha Apollo Hospital, New Delhi, India.

Top 5 Maze Surgery hospitals in India:

Most of the top heart surgery hospitals in India are performing maze surgery or cox-maze IV procedures in India with the highest success rates. The top maze surgery or cox-maze IV hospitals in India are:

• Fortis Escorts Heart Institute, New Delhi, India.
• Indraprastha Apollo Hospital, New Delhi, India.
• Max Super Specialty Hospital, New Delhi, India.
• Manipal Hospital, New Delhi, India.
• Medanta - The medicity hospital, Gurugram, India.

Frequently asked questions about Maze surgery or Cox-Maze IV procedure:

A Maze surgery effectively treats atrial fibrillation (irregular heartbeats). The newest version of maze surgery is the Cox-maze IV procedure. It is considered the Gold Standard for the treatment of Atrial Fibrillation ( Afib).  At CMCS Health. we offer cost-effective Cox-Maze IV procedures at the top heart hospitals in India. Our Best Interventional cardiology surgeons in India use the latest techniques to perform successful Cox-maze IV procedures for international patients seeking atrial fibrillation treatment in India. The most frequently asked question about maze surgery or Cox-maze IV procedures could be:

Why will I need a Maze surgery?

Anyone having atrial fibrillation that poses the risk of a stroke and congestive heart failure has to undergo atrial fibrillation (Afib) treatment. When treatments like medication, cardioversion therapies, and nonsurgical cardiac catheterization procedures ( like cardiac ablation ) fail to treat Afib, the treating doctors will advise for a maze surgery or its latest version Cox-maze IV procedure.

Is the maze procedure an open heart surgery?

Maze surgery can be done by both the open heart surgery approach (sternotomy) and the minimally invasive thoracoscopic approach ( including the robot-assisted maze procedure). The treating heart specialist doctor will carefully assess which surgery will be better for every individual patient and discuss the options with the patient. 

Can maze surgery be done as a stand-alone surgery?

Maze procedure can be done as a stand-alone therapy or even as a combined surgery for any other heart ailments like a valve repair/replacement surgery or coronary artery bypass graft ( CABG) surgery. The treating doctor will decide the treatment modality after carefully considering the patient's medical condition.

What is the success rate of the Maze procedure in India?

The success rate of maze surgery or Cox-maze IV procedure for Afib treatment is as high as 80% to 90%. The maze procedure provides treatment for Afib and reduces the risk of a brain stroke and congestive heart failure.

                                       Your heart deserves the best, give it the best care with your global healthcare guardian - CMCS Health.