[Havin' A Party!]

Originally Posted by Dinith88

... A surgical MAZE/openheart/bypass-pump procedure done soley to 'cure' AF is rarley done and reserved for severley debillitating(sp?) cases refractory to all the conventional treatments...or so i thought?

Believe this is absolutely correct. Tremendous amount of trauma and lengthy recovery.

Hugely successful though for AF, from what I've read.

[versatile_kat]

Hey guys, just wanted to let you know that Maze doesn't stand for anything ... it means exactly what it is - a "maze" inside the right atrium for the SA node to fire to the AV node through. All of the scar tissue inside the atria (which takes on average about 4 weeks to develop) makes a pathway for only one electrical impulse (SA to AV), instead of several aberrant impulses as with afib. It's an excellent procedure with (I believe) a 98% success rate for chronic afibbers. Please correct me if I'm wrong . I work in a busy cardiac surgical unit that has recently done about one maze a week (along with the cabg), but you're right, it doesn't happen all that often. Hope this info helps!

[Dinith88]

VersatileCAt..yes, the lesions resemble a 'maze' which is where the term comes from...but otherwise you're description is wrong. Actually, the primary heart chamber is the LEFT atrium..(and the right in a 'full' MAZE)..but a 'modified' MAZE can be done on just the Left Atrium. Also, the lesions don't form a maze or 'road' for the impulse to follow...RATHER, the lesions are an attempt at isolating the pulmonary veins (which empty into the left atrium). The reason isolating the pulmonary veins is important is because it's been determined that in alot of cases of a-fib, the ectopic discharge that can initiate a PAC..and then AF comes from the sites where the pulmonary veins 'connect' to the left atrium. These lesions dont 'guide' the normal sa-av impulse...instead, they 'block' bad/ectopic ones from 'spreading' and causing the AF.

Is your facility doing curative Maze procedures soley for a-fib, or are they done during other procedures (CABG, or (more frequently, MVR)?

[dianah]

As an aside (and I am just learning in this area), one of our cardiologists taught us that while baby is being formed in the uterus, sometimes little aberrant electrical pathways form in the heart. Later on in life they cause problems by providing aberrant conduction for the heart's electrical system. By eliminating these pathways (cutting them off w/the Maze procedure, or isolating and cutting them off with an ablation), the aberrant conduction (thus aberrant rhythm, aberrant re-entry, whatever) is stopped (hopefully). VERY interesting area, this cardiac electrophysiology. Keep on learning! -- D

[josiebean927]

I have had one patient that had the Maze procedure performed while she had and AVR and I never was quite clear on what it was. This has been very informational. Thanks everybody.

[versatile_kat]

Dinith88 ... thanks a lot for the clarification! I wasn't given a very exact definition of what the maze procedure is by our surgeons ... just a "basic run down". And from what I've looked at on-line, I'd never read anything on isolating the pulmonary veins. Would you mind sharing your source for this information? I'd like to have it to give to the nurses on the unit.

And our hospital doesn't perform the Cox-Maze solely on it's own ... the paitent either has a cabg or mvr in conjunction.

[mrsituation]

MAZE aka MAZE/COX procedure....
http://www.clevelandclinic.org/heart...ation/maze.htm

In theory; surgical slits are made in atrial wall and create scar tissue. it is the scar tissue that inhibit the abnormal electrical conduction from SA --> AV node. Since that is interrupted then the heart's own inherent conduction system then originates from the AV node. For a more detailed explanation, check out the hotlink, hope it helps.

[Spatialized]

Our surgeons have only been doing a MAZE if the patient is open to begin with. They're not going to open them up just for a MAZE. Besides, our EPS guys would cry foul if they started doing that.
Anyone doing "cryo-MAZE"? Guess instead of radio-frequency or sharp surgical cuts, they're using freezing to get the same effect. I haven't really looked into it, but need to. Was curious.
And yes, it was a little rude of your mentor to say, "look it up", but I think their heart was in the right place. My gut tells me that they were trying to foster a sense of self-sufficiency, but may have taken a wrong way of doing that. Make sense? Maybe I'm way off.

Cheers,
Tom

[mrsituation]

Hey Y'all!! Here are my 2 cents on the whole precepting thing...
I have noticed similar complaints on different blogs and now feel the need to have my voice heard. Certain axioms occur in all facets of a teacher/student relationship; Just because you've been doing it longer doesn't make you better, quicker maybe, but not better. Just because you can do, doesn't mean you can teach. To excel in the clinical setting you need certain personality traits (confidence, versatility, assertiveness) and to teach you need other traits(patience, and the ability to convey thoughts & goals to your student). I look at this from 2 different perspectives, In my past life prior to Nursing I was a paramedic and often had a role as a clinical instructor and preceptor. Now, as a Nurse, every time I work some place new I can enjoy the student aspect and all too often seen the downside in nursing. To precept, is to teach; hopefully one does this with the goal of creating an asset on the unit not with the goal to "get my shot at the power play with the FNG". Asking someone to do research has its time and place; like at the end of the day not while you are taking care of a certain disease process. I believe that the same goal could have been reached by giving you the down and dirty of a MAZE procedure while the case came in so you could adequate take care of your patient and at the end of the day, tell you to look up the procedure. Next time I saw you, ask if you learned anything you didn't know. The beginning of a precepting shift should have reachable goals and the end of a precepting shift should have a debriefing so you can reflect afterwards and ultimately learn. If there were mistakes made, then more than likely you won't do them again. These are concepts that I used in EMS in the military, tactical and civilian environments; I rarely see them used in Nursing.

[TopherSRN]

Originally Posted by zambezi

Our cardiac surgeons occassionally do maze procedures while they are doing a cabg or valve...with the maze procedure, tiny cuts are made on the myocardium (i believe with a laser) to ablate alternate pathways...

Your getting Transmyocardial Revascularization (TMR) and a MAZE confused. TMR is where a laser is used to 'drill' holes through the myocardium in order to promote collateral capillary beds as a method of perfusion.

A MAZE is a procedure where the atria and the pulmonary veins are surgically manipulated in order to reorganize the internodal pathways.


And YES you will see asystole, junctional, a flutter and EVEN afib in someone s/p MAZE. A fib will persist for up to 6 months. Its akin to seeing the wierd conductions in valves.


She told you to look it up because you will remember it better than if she had just told you. How hard is it to look things up these days with google?