Maze Procedure for Arrhythmia

The heart’s pumping action is controlled by an electrical system that sends out impulses, or signals. As long as the electrical impulses are transmitted normally, the heart pumps and beats at a regular pace. An arrhythmia – or irregular heartbeat – is a disturbance in the normal transmission of these impulses.

What is Arrhythmia?

An arrhythmia causes the heart to pump and beat at an irregular pace – the heart may beat too fast or too slowly, or may skip beats.

Tachycardia

When the heart beats faster than it should, more than 100 beats per minute, it is called tachycardia. Most arrhythmias that fall into this group can produce symptoms of palpitations, rapid heart action, dizziness, lightheadedness, fainting or near fainting. In some cases, tachycardia can cause sudden cardiac death. Forms of tachycardia include:

• Sinus Tachycardia
• Supraventricular Tachycardia
• Atrioventricular Nodal Reentrant Tachycardia
• Bypass Medicated Tachycardia
• Atrial Tachycardia
• Atrial Flutter and Fibrillation
• Ventricular Tachycardia
• Ventricular Fibrillation

Bradycardia

When the heart beats slower than it should, less than 60 beats per minute, it is called bradycardia. Less common than tachycardia, these arrhythmias can cause fatigue, dizziness, lightheadedness, fainting or near-fainting spells. In serious cases, bradycardia can even cause cardiac arrest. Forms of bradycardia include:

• Sinus Bradycardia
• AV Nodal Block, including complete heart block

Treatment for Arrhythmia

The treatment options available to a person with arrhythmia depend on the severity of the condition. Some patients may not require any intervention. Others may be prescribed medications, while others may opt for electrophysiology procedures such as catheter ablation.

Surgery for arrhythmia also is an option. The Maze procedure may be appropriate for patients for whom medication and ablation have not been successful and for patients who require surgery for other reasons in addition to their atrial fibrillation. The Maze procedure creates scars to stop the arrhythmia in a manner similar catheter ablation procedures. The main difference is that the scars are created under direct vision, usually with the chest open.

Some persons with arrhythmia may require a pacemaker or pacemaker/defibrillator. In many cases, these devices are implanted using a catheter. They are placed under the skin of the upper chest, with wires (leads) threaded through chest veins into the heart. However, some patients need to have these leads placed on the outer surface of the heart (epicardium) instead of, or in addition to, inside the heart chamber. Surgery is the best method for these patients.

Considered forms of “open heart” surgery, the Maze procedure and epicardial lead implantation both traditionally involve sternotomy – cutting through the breastbone and opening the ribs. This can cause significant trauma, prolong healing time and increase the risk for serious complications and even mortality.

Robotic-Assisted Maze Procedure and Epicardial Lead Implantation: Less Invasive Options

The robotic-assisted Maze procedure and robotic-assisted lead implantation are minimally invasive alternatives to traditional approaches.

When performed robotically with the da Vinci Surgical System, the Maze procedure and lead implantation is done with unparalleled precision and control through a few small incisions along the side of the chest.

Benefits of Robotic-Assisted Maze Procedure and Epicardial Lead Implantation

In addition to avoiding the pain and trauma of sternotomy and rib spreading, this may provide patient benefits such as:

• Less risk of infection
• Less blood loss and need for blood transfusions
• Shorter hospital stay
• Significantly less pain and scarring
• Faster recovery
• Quicker return to normal activities

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While the robotic-assisted Maze procedure and robotic-assisted lead implantation are considered safe and effective, they may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

Illustrations courtesy of Intuitive Surgical, Inc.