Question on MAZE procedure

Specialties CCU

Published

I am currently on a cardio thoracic placement, and and was caring for a patient following CABG3 and MAZE procedure. I have never heard of a Maze procedure so I asked my mentor and their responce was to look it up in a journal.

I have tried various journals but with no real sucsess, I have tried google and found some interesting websites, which lead me to a belief that MAZE is an American discovery/technique...

I have tried seraching British journals for information and have had only one hit in the BMJ for MAZE procedure, but I found some other articles which speak of 'Radiofrequency ablation for atrial fibrillation' is this the same as a MAZE procedure?

Because to me they sound the same, but I hoped to get another opinion.

Thanks in advance

Whisper

Specializes in CCU/CVU/ICU.

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)?

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

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 -- D

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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.

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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". :rolleyes: 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.

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Specializes in ER, ICU, Transplant.

MAZE aka MAZE/COX procedure....

http://www.clevelandclinic.org/heartcenter/pub/atrial_fibrillation/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.

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Specializes in Cardiac Telemetry/PCU, SNF.

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

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Specializes in ER, ICU, Transplant.

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. :w00t:

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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?

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Specializes in CVICU, MICU, CCRN-CSC.
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...as others have mentioned, it is ususally used for those that have chronic afib...in my experience, these patients often have some bouts of junctional rhythm after surgery, occassionally requiring pacing...

That sounds like a TMR to me, not a MAZE.

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Specializes in CVICU, MICU, CCRN-CSC.
MAZE aka MAZE/COX procedure....

http://www.clevelandclinic.org/heartcenter/pub/atrial_fibrillation/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.

We are going to be one of the hospitals doing the COX Maze IV. It is for persistant or long lasting (Class II or III) afib. It isolates all places between the RPV and the LPV and "draws a line" from between the two upper PV and down to the mitral valve. We will do this though a small thoracotomy incision. Just like we do the Cox Maze III now. We do do these in conjuction with CABG. Our MD's, a cv surgeon and our EP MD that will be doing it are in training this week and we will have our first case (out of the 11 on the waiting list, next week). It has a longer success rate. :bugeyes::bugeyes:

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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?

It has been interesting reading re the MAZE proceedures, our Hospital does the largest amount of Cardiac Surgery in our state and the MAZE is only ever done in conjunction with valve or CABG. Our Cardiologists/Electrophysiologists do Alcohol Abalation via a femoral approach for those patients that have AF. And as previously stated the arrythmias post proceedure are variant and if the full affect of either the MAZE or the Alcohol Ablation take between 3 and 6 months and even then there is no guarantee that they are successful. The proceedure is as you say on here - related to the pulmonary veins and internodal pathways. Thanks for taking my 2 cents worth.

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Specializes in CCU/CVU/ICU.

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. , hope it helps.

Just to clarify...because this statement is in error...and may confuse people...

The scar tissue created in MAZE procedures blocks 'bad' conduction/impulses that origionate in the left atrium (at the junction of the 4 pulmonary veins and the atrium)...NOT "abnormal SA node conduction". (impulses origionating from SA node are called 'sinus'). And, if the heart's "...own inherent conduction system then origionates from the AV node..." the rhythm would be 'junctional' not 'sinus'...(goal of MAZE is to restore sinus rhythm, not induce junctional)

Didnt get a chance to read your link but if it is where your information came from it's a bad link...

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